Many of the books, seminars, conferences, webinars, and podcasts I have read and participated in consistently recommend taking at least 3 grams of omega 3 (EPA/DHA) fish oils as supplements and food to improve cardiovascular health.

For many years, this has been my recommendation for many patients.

However, after reviewing the literature and hearing concerns among patients experiencing episodic heart palpitations, I am now questioning the necessity of making a “global” recommendation of fish oils to ALL patients.

Unfortunately, the topic of fish oil recommendations is somewhat complicated. However, there is a simple solution to ensure you are not over-prescribing fish oils, creating cardiovascular complications, but instead helping your patients achieve optimal cardiovascular health.

A recent peer-review paper published in the British Medical Journal in 2024 stated the following:

 

The researchers discovered that regular use of fish oil supplements could increase the risk of first-time heart disease and stroke among those with good heart health. A 13% increased risk of developing atrial fibrillation was found in their study.

They also had a 5% increased risk of stroke.

For the study, the team analyzed data from nearly 416,000 people ages 40 to 69 participating in a large-scale health study in the United Kingdom. 

 

Nearly a third (32%) said they regularly use fish oil supplements.

 

The research team then tracked the health of participants for an average of nearly 12 years, watching to see how many died, developed heart problems, or suffered a stroke.

During an average monitoring period of nearly 12 years, 18,367 participants developed atrial fibrillation, 22,636 had a heart attack/stroke or developed heart failure, and 22,140 died.

Among those who progressed from good cardiovascular health to atrial fibrillation, 3085 developed heart failure, 1180 had a stroke, and 1415 had a heart attack. And 2436 of those with heart failure died, as did 2088 of those who had had a stroke, and 2098 of those who had had a heart attack.

However, the long-term study also found that fish oil can help those whose hearts are already in trouble, potentially slowing the progression of heart problems and lowering the risk of death.

But in those with existing heart disease, regular use of fish oil lowered the risk of a heart attack due to atrial fibrillation by 15% and the risk of heart failure leading to death by 9%.

Regular use of fish oil supplements might increase, rather than lessen, the risk of first-time heart disease and stroke among those in good cardiovascular health, but they may also slow the progression of existing poor cardiovascular health and lower the risk of death.

 

The researcher concluded that regular use of fish oil supplements might have different roles in the progression of cardiovascular disease” based on whether someone already has heart problems.

Neurologist Dr. Richard Isaacson, director of research at the Institute for Neurodegenerative Diseases in Boca Raton, Florida, told CNN that when it comes to fish oil, “the devil is in the details.”

If you are like me, you may be scratching your head, wondering if it is safe to take fish oils or simply avoid them altogether.

The answer, as mentioned above, is quite SIMPLE.

It all comes down to testing and obtaining clear objective metrics to determine if one is genuinely deficient in omega-3 fatty acids.

This can be done by placing a lab order with Labcorp or Quest for the OmegaCheck Test. The Labcorp Code is 823430, and the Quest Code is 92701

The following are two recent patients of mine, both suffering from complicated cardiovascular issues (atherosclerosis, endothelial (arterial) dysfunction, hypertension, hypertriglyceridemia, and insulin resistance)

The OmegaCheck lab results below clearly indicate that both patients were significantly depleted in Omega-3 fatty acids, and it would be prudent to recommend them in these two cases.

The optimal level I strive to achieve when ordering the OmegaCheck is 8.

 

 

 

 

 

 The motto is clear: You don’t want to take fish oil if you don’t need them. It is as simple as that.

I have another motto: Test, Don’t Guess

Comments and Recommendations

Regular use of fish oil supplements has different roles in cardiovascular health, disease progression, and death.

Fish oil supplements might be a risk factor for atrial fibrillation and stroke among the general population but could also be beneficial in reducing the progression of cardiovascular disease.

Again, this important article outlines that I DO NOT randomly prescribe fish oils without ordering the OmegaCheck from Labcorp or Quest.

It has proven to be an extremely valuable test for determining whether a patient needs extra omega-3 fatty acid supplementation or should not increase their intake of fatty acid supplementation.

Of course, I strongly recommend rechecking your OmegaCheck 90 days after they begin taking extra omega-3 fatty acids if you find they are deficient.

When you see the OmegaCheck is approximately at the 8 level, back off on the omega-3 three fatty supplements and consider a lower maintenance level.

I recommend getting omega-3 fatty acids from sardines, mackerel, anchovies, and wild-caught salmon.

I do not recommend farm-raised salmon because of impurities in the water they are raised in. This may be a bold statement, but farm-raised salmon is unhealthy for human consumption and does not have the omega-three fatty acid levels that wild-caught salmon have.

The Issue of Obtaining Omega 3 Fatty Acids from Eating Flaxseed and Chia Seeds.

I have discovered, to my discouragement, that regular consumption of Flaxseed and chia seeds does indeed have many health benefits; however, the conversion rate from alpha-linolenic acid (ALA) to eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA) is low and inconsistent. Many plant-based proponents have claimed that eating Flaxseed and chia seeds is the solution to increasing Omega 3 fatty acids because the ALA found in Flaxseed and chia seeds will easily convert to EPA and DHA.

I will have to disagree with the above statement.

While most research suggests a conversion rate of ALA to EPA of 5%, some have suggested that the conversion rate can be lower or even zero. The key point is that individuals consuming Flaxseeds and chia seeds with the intention of obtaining meaningful levels of omega-3 fatty acids will not be fulfilling their aims through such products.

In short, consuming even large quantities of Flaxseed and chia seeds may well be good for you generally, but as sources of bioavailable Omega-3s, they are probably not so useful.

 

References:

https://bmjmedicine.bmj.com/content/3/1/e000451
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8756005/
https://www.cedars-sinai.org/newsroom/omega-3-supplements-could-elevate-risk-of-atrial-fibrillation/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10175873/
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.058596
https://jamanetwork.com/journals/jama/fullarticle/2777450
https://pubmed.ncbi.nlm.nih.gov/35647665/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023944/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5674268/
https://www.clinicalnutritionjournal.com/article/S0261-5614(20)30381-2/fulltext (copy and paste link in browser)
https://www.atherosclerosis-journal.com/article/S0021-9150(13)00614-X/fulltext (copy and paste link in browser)
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2018.00336/full
https://www.sciencedirect.com/science/article/abs/pii/S1098882317300485
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5872768/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5496233/