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Omega-3s and Heart Disease: The Latest Study


On Wednesday, September 12, a research paper was published in the Journal of the American Medical Association (JAMA)[i] which left many people confused about one of the most-researched, fundamental nutritional supplements available today: omega-3 fatty acids, commonly known as fish oil. The conclusions of the study created doubt about the efficacy of using fish oil on a daily basis for heart health.

As is typical of media headlines, they don’t tell the whole story. Similar to the media headlines about cigarettes and egg yolks being equally risky for your heart, the study suggesting omega-3s don’t offer health benefits requires more explanation than most media sources provided.

Omega-3 Fatty Acids

Omega-3 fatty acids are one classification of essential fatty acids, meaning they are essential for life. Omega-3 fats in the diet can be found as alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Most processed food products with added omega-3s contain ALA, which is usually derived from plants. In order to provide the health benefits associated with omega-3 consumption, ALA must be converted to EPA and DHA. However, most people are poor at converting these fatty acids, so it’s best to consume EPA and DHA directly. The best sources are fatty fish and high-quality, supplemental fish oil. The top 15 food sources are shown below, with the data coming from the USDA.

For comparison, one fish oil softgel typically contains 300-600 mg of EPA and DHA. Higher-quality fish oil is usually more concentrated, containing a higher amount of EPA and DHA in each softgel. The oil is also processed better to ensure it does not become rancid. Since most people don’t eat the fish listed above on a daily basis, it’s more realistic to meet suggested omega-3 intake through quality fish oil supplementation.

The main premise behind omega-3 supplementation is to balance out the ratio of omega-3 fatty acids in the diet compared to the consumption of omega-6 fatty acids, commonly found in vegetable oils like corn and soybean oil. Traditionally, humans consumed omega-6 and omega-3 fats in a ratio of about 4:1 to 1:1. However, our high consumption of omega-6 fatty acids has pushed the ratio of omega-6 to omega-3 up to 20:1 or higher.

The problem is, many of the omega-6 fatty acids tend to promote inflammation. Chronic inflammation creates a number of problems in the body, one of which is the promotion of atherosclerosis. By consuming more omega-3 fatty acids and fewer omega-6 fatty acids, we may reduce inflammation, which is thought to be a big reason why omega-3s are important for heart health. Again, though, not all omega-3s are created equal. What we’re talking about for heart health is EPA and DHA, found in marine foods, not ALA commonly found in plants.

There are other benefits to fish oil, but one of the main benefits for heart health is the reduction of inflammation. Many nutrition experts have touted this benefit for reducing the risk of heart disease, so it came as a surprise that a study would suggest there isn’t a benefit for heart health. How did that happen?

The Study

The study published in JAMA was not an actual research study, but rather a study of selected studies, called a meta-analyses. Of the more than 3000 studies and research papers on omega-3 fatty acids, they narrowed their meta-analyses down to 20 studies. They combined these particular studies because they had certain similarities that others did not.

By selecting the studies in the design they did, the majority of the weight of their findings relied on just three studies, Tavazzi et al., ORIGIN, and Marchioli et al., which used daily targets of omega-3 intake of just one gram, one gram and 0.85 gram respectively. Herein lies one of the issues with the study. As mentioned above, the goal of omega-3 fatty acids should be to help balance out the omega-6:omega-3 ratio. Just one gram per day is unlikely to significantly alter that ratio.

The effects of imbalanced omega-6 and omega-3 consumption can take years to develop. For heart health, the benefit of omega-3 fatty acids are seen in their potential to reduce inflammation, which could then help reduce the likelihood of developing heart disease. They should not be seen as a way to reverse heart disease. Those with pre-existing heart disease may still benefit from them, but they are not to be used the way drug therapy is.

A second flaw in the meta-analysis was the age and state of health of the participants. Many of those in the studies were older and already had heart disease. Of the 20 studies, one group had an average age of 49 years, a second group had an average age of 57, and the rest had average ages in the 60s and 70s. Heart disease develops over a period of years and is often well-developed in the 6th and 7th decade. If individuals at this age are studied for just a year or two, it’s expected that omega-3 use won’t show a significant benefit. In addition, a significant number of these individuals were being treated for heart disease, so they were also on drug therapy, which would reduce the impact of omega-3 use.

A third issue with looking at the treatment effects of omega-3 fatty acids is the short duration of these studies. Because inflammation attacks the body over a periods of many years, or even decades, the effects of omega-3 fatty acids for heart health would likely not be seen except in a controlled study spanning many more years.

More Than Heart Health

Although omega-3 fatty acids are often advertised for their heart health benefits, there is much more in the body that they do. The way the media downplayed the use of omega-3 consumption is unfortunate, as many people only heard “omega-3s don’t work.” What they really should have been told was that over the course of a year or two, supplementing with just a gram of EPA and DHA per day in those with pre-existing heart disease may not reduce the risk of future heart problems. Of course, that doesn’t sound as extreme, but it is more accurate. In addition, the use of omega-3 fatty acids has been shown to reduce psychological stress, support brain cell development, reduce depression, enhance eye health, increase metabolism and a number of other benefits.

On a positive note, the study put omega-3s in the headlines again. Unfortunately, people are already confused about nutrition and supplementation. Never change your nutrition habits by simply reading a headline. Before jumping to conclusions, seek out a knowledgeable dietitian or other Health and Fitness Professional who can provide a more detailed explanation of what you should know.

As a final note, I had the fortune of exchanging emails with Dr. Doug Bibus, one of the world’s most-renowned experts in essential fatty acids. He has extensively studies omega-3s throughout his career. Regarding the study, Dr. Bibus said:

“The past 40 years of research have demonstrated the value and essential nature of omega 3 fatty acids in promoting health especially cardiovascular health. Should you follow the advice of Dr Rizos in this paper to not take fish oil or omega 3 fatty acids to prevent heart disease? Absolutely not. Science firmly supports the cardiovascular protective effects of omega 3 for a healthy body, heart and mind.”

Personally, I’ll still take my three fish oil softgels with breakfast and dinner each day. I’m confident they’ll benefit my heart as I age, and provide a ton of other health benefits as well.

Post questions or thoughts below.

Written by Tom Nikkola – Director of Nutrition & Weight Management

This article is not intended for the treatment or prevention of disease, nor as a substitute for medical treatment, nor as an alternative to medical advice. Use of recommendations in this and other articles is at the choice and risk of the reader.

[i] Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease Events. JAMA 2012;308(10):1024-1033

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Reader Comments (8)

Hey Tom - Thanks again for being there to support and defend Life Time Fitness's Nutrition Philosophy! As an employee it’s nice to know we have a trusted, well educated professional that has our back! :)

September 17, 2012 | Unregistered CommenterKeri

Here's NBC's headline on the subject: "A study concluded fish oil supplements do neither harm nor good, but it also showed that people taking fish oil supplements suffered nine percent fewer heart deaths and 11 percent fewer heart attacks."

I haven't red the JAMA article, but I was surprised you didn't mention these reduction numbers in your story. And how can the study authors say that the study concluded that fish oil did not do any good, if it reduced heart deaths by 9% and heart attacks by 11%?

September 23, 2012 | Unregistered CommenterCarlos

Whereas the jury is still out on this topic, I agree that meta analyses are flawed in many ways that you cite, and unfortunately they are exalted as the current fad in "evidence-base medicine". Most of them are not heavy on Class 1 or even 2 studies. There are a lot of bad protocols out there, including in the supplement and alternative/complementary medicine world as well. Science is a difficult task master but is the best we have to find truth, and it takes years often to find it.

Good writing, sir.

good article Tom,

the reduced heart attacks and reduced deaths statistic did not reach statistical significance which is probably the reason for not mentioning it.

I will note that the strength of this study, in my opinion, is that they narrowed the focus to doses that were very close to being fully consistent with the u.s. government recommendations. while there may be a divergent recommendation from various groups this study does give strong indication that the governments recommendations do not show heart disease, stroke or all cause mortality benefit over 1 year or slightly more.

to recommend taking higher doses, and longer term consumption would be a totally seperate experiment, which does not have strong research in support of or against at least in terms of quantitative data

September 24, 2012 | Unregistered Commenterdavid ramsey

Another interesting point of view would be comparing / contrasting omega 3 fatty acid consumption through supplementation vs. through eating actual fatty fish. Many supplements when taken at high dosages have failed to demonstrate a health benefit, and as is typical with medical care, there is a threshold at which they become risky. This has even been shown for supplements that used to be recommended for heart health like vitamin E and Beta-Carotene. Great article! What are your thoughts on the prescription fish oil, Lovaza, indicated in the treatment of hyper-triglyceridemia?

September 24, 2012 | Unregistered CommenterEthan Lazarus MD

Why do you take such a high dosage each day, Tom?/ Where do you get your recommendation to take that amount?

September 24, 2012 | Unregistered CommenterRoberta

Great article Tom. As always, I encourage people to do research and read up on their own. I take 3 softgels in the AM and 3 in the PM as well, and my latest bloodwork shows my HDL at 74mg/dl and my total cholesterol to HDL ratio is 1.8:1. As a 40 year old male, I'll keep taking my omega 3's!

September 25, 2012 | Unregistered CommenterSkip Gagnon

It gives me about 3.6 grams of EPA and DHA per day. I had my omega-3 levels checked and they were at an optimal level, so I'm keeping it up. My omega-6 intake is pretty low. If I ate processed foods, corn/soybean oil, I may take in more, but the 6 softgels (3 in the morning, 3 in the evening) serve me well.

September 30, 2012 | Unregistered CommenterTom Nikkola

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