Feb. 5, 2019 -- If you take a handful of supplements every morning, chances are fish oil is among them.
SLIDESHOWThe global value of the fish oil market is expected to surpass $4 billion by 2022. Enthusiasts say it can help with age-related macular degeneration, rheumatoid arthritis pain, high cholesterol, asthma, depression, ADHD, heart disease, and may even help you get gorgeous hair.If that all sounds too good to be true, well, you know. …But before you throw out your fish oil like 3-day old fish, get the facts. It may have some benefits for your heart, your joints, and your brain. But there are caveats.
What You Need to Know About Omega-3s
Why They're a Good Fat
Not all fats are unhealthy. Omega-3 fatty acids are one of the "good" types of fat. They may help lower the risk of heart disease, depression, dementia, and arthritis. Your body can't make them. You have to eat them or take supplements.
Know the 3 Types of Omega-3s
Omega-3 fatty acids come in more than one form. The types found in fish, called DHA and EPA, seem to have the strongest health benefits. Another form known as ALA is found in vegetable oils, flaxseed, walnuts, and dark leafy vegetables such as spinach. The body can change a small amount of ALA into EPA and DHA, but not very well.
How Omega-3s Fight Disease
Omega-3 fatty acids help your heart in several ways. They curb inflammation in the blood vessels (and the rest of your body). At high doses they also make abnormal heart rhythms less likely and lower your level of blood fats called triglycerides. Finally, they can slow plaque buildup inside the blood vessels.
If You Have Heart Disease
The American Heart Association recommends 1 gram a day of EPA plus DHA for people with heart disease. Eating oily fish is best, but your doctor might recommend a fish oil capsule. If you've had a heart attack, a prescription dose of omega-3s may help protect your heart. Some studies show fewer heart attacks and fewer heart disease deaths among heart attack survivors who boosted their levels of omega-3.
Helping Your Heart's Rhythm
Omega-3s seem to have a stabilizing effect on the heart. They can lower heart rate and help prevent arrhythmias (abnormal heart rhythms). Several common sources of omega-3s are fish, walnuts, broccoli, and edamame (green soybeans that are often steamed and served in the pod).
Omega-3s DHA and EPA can lower your triglycerides, a blood fat that’s linked to heart disease. Talk with your doctor before taking omega-3 supplements, because some types can make your "bad" cholesterol worse. You can also bring down triglyceride levels by exercising, drinking less alcohol, and cutting back on sweets and processed carbs like white bread and white rice.
Lowering High Blood Pressure
Omega-3s can help lower blood pressure, a bit. One plan is to replace red meat with fish during some meals. Avoid salty fish, such as smoked salmon. If you have high blood pressure, limiting salt is probably one of the things your doctor has recommended.
Do They Help Prevent Stroke?
Omega-3 foods and supplements curb plaque buildup inside blood vessels, helping with blood flow. So they may help prevent stroke caused by clots or a blocked artery. But at high doses, omega-3 supplements might make bleeding-related stroke more likely; so check with your doctor.
Useful for Rheumatoid Arthritis
Studies suggest omega-3s can curb joint pain and stiffness in people with rheumatoid arthritis. A diet high in omega-3s may also boost the effectiveness of anti-inflammatory drugs.
Depression and Brain Benefits?
Depression is rarer in countries where people eat a lot of omega-3s in their typical diet. But omega-3s aren't a treatment for depression. If you're depressed, talk with your doctor about what might help you feel better.
May Help With ADHD
Some studies suggest omega-3 supplements may ease the symptoms of ADHD. Omega-3 fatty acids are important in brain development and function. Omega-3s may provide some added benefits to traditional treatment, but they don't replace other treatment.
Research on Dementia
The jury is still out, but there's some evidence that omega-3s may help protect against dementia and age-related mental decline. In one study, older people with a diet high in omega-3 fatty acids were less likely to get Alzheimer's disease. More research is needed to confirm the link.
Omega-3 and Children
Be wary of promises that omega-3s have "brain-boosting" powers for children. The Federal Trade Commission asked supplement companies to stop that claim unless they can prove it scientifically. The American Academy of Pediatrics does recommend that kids eat fish, but cautions against types that are high in mercury, such as shark, swordfish, king mackerel, and tilefish.
Catch of the Day
The best source of omega-3 fatty acids DHA and EPA is fish. Some varieties deliver a higher dose than others. Top choices are salmon, mackerel, herring, lake trout, sardines, anchovies, and tuna. The American Heart Association recommends at least two servings a week of fish. A serving is 3.5 ounces of cooked fish or 3/4 cup of flaked fish.
Tuna can be a good source of omega-3. Albacore tuna (often labeled "white") has more omega-3 than canned light tuna, but it also has a higher concentration of mercury contamination. The amount of omega-3 in a fresh tuna steak varies, depending on the species.
Avoid Contaminated Fish
Due to its important nutrients for growth and development, and low intakes the FDA changed from limiting fish consumption to encouraging it. For most people, mercury in fish is not a health concern. But the FDA has this advice for young children and for women who plan on becoming pregnant, are pregnant, or are nursing:
- Eat 8-12 ounces of fish per week (which is equal to 2 or 3 servings a week). Provide kids age-appropriate portion sizes. Limit albacore tuna to 6 ounces per week.
- Choose fish lower in mercury, such as salmon, shrimp, pollock, tuna (light canned), tilapia, catfish, and cod.
- Avoid shark, swordfish, king mackerel, and tilefish, and limit albacore tuna to no more than 6 ounces a week.
- When eating fish caught locally, check fish advisories or limit fish to 6 ounces for women and 1-3 ounces for children and do not eat fish for the rest of the week.
If you don’t like fish, you can get omega-3 from supplements. One gram per day is recommended for people with heart disease, but ask your doctor before starting. High doses can interfere with some medicines or increase risk of bleeding. You may notice a fishy taste and fish burps with some supplements. Read the label to find the amounts of EPA, DHA, or ALA you want.
Vegetarian Sources of Omega-3s
If you don't eat fish or fish oil, you can get a dose of DHA from algae supplements. Algae that is commercially grown is generally considered safe, though blue-green algae in the wild can contain toxins. Vegetarians also can get the ALA version of omega-3 from foods such as canola oil, flaxseed, walnuts, broccoli, and spinach -- or products fortified with omega-3s.
Avoid the Omega-3 Hype
Many food products now boast that they have added omega-3 to support various aspects of your health. But be aware that the amount of omega-3 they contain may be minimal. They may contain the ALA form of omega-3, which hasn't yet shown the same health benefits as EPA and DHA. For a measured dose of omega-3, taking fish oil supplements may be more reliable.
Reviewed by Christine Mikstas on 5/29/2018
What Is Fish Oil?Doctors and scientists first took notice of fish oil when research revealed that cultures that ate more fish -- Scandinavians and Inuits, for example -- had lower rates of heart disease. Many types of fish, including salmon, mackerel, herring, lake trout, sardines, and albacore tuna, contain omega-3 fatty acids -- a healthy type of fat. Two of the most important omega-3s in fish are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Researchers wanted to know whether taking fish oil straight -- without eating fish -- might help the heart.“In clinical trials, the results are very mixed,” says J.L. Mehta, MD, PhD, a cardiologist and professor at the University of Arkansas for Medical Sciences in Little Rock. “Some show benefits. Many do not.”
Why the Mixed Reviews?Early tests showed that fish oil helped the heart in many ways, but researchers have scratched their heads when more recent studies didn’t get the same results.“This may be because there are so many medications that are now being used to treat high-risk patients. A very large percentage are on aspirins, statins, beta-blockers, ACE inhibitors, and this may obscure the role of a dietary supplement like omega-3s,” says JoAnn Manson, MD, chief of preventive medicine at Brigham and Women’s Hospital in Boston.It may also be that Westerners eat more fish today than they once did because they’ve heard it’s good for them, so a supplement wouldn’t help. Different studies also use different fish oil doses and formulations -- whether they are equal parts EPA and DHA or heavier on one than the other.
The Evidence for Fish OilIf you’ve already had a heart attack or are at a high risk of having one …Large prescription-strength doses of pure EPA -- not the type you buy off the shelf at the drugstore -- can help the hearts of people who have certain conditions that make heart problems more likely. Prescription fish oils lower triglycerides -- a type of fat that circulates in the bloodstream. A recent study showed that 4 grams of pure EPA per day for 5 years significantly cut the risk for heart attack, stroke, bypass, chest pain, and death from sudden cardiac arrest during that time.
But it’s worth noting that the people who saw these benefits already had a host of heart-related health problems. Their LDL, or “bad,” cholesterol and triglycerides were high even though they took cholesterol-lowering medications. They also already had heart disease, or they had diabetes and at least one other thing that made heart disease more likely.For people who’ve never had a heart attack and run a normal risk of ever having one, says Manson, “it’s unlikely that 4 grams a day would be recommended. There’s a threshold at which you’d stop seeing benefits.”A similar study found that a prescription form of 1.8 grams of EPA per day, in addition to a cholesterol-lowering medication, cut the odds of having heart attacks and other heart problems in people who had high cholesterol. Many of them also had heart disease, diabetes, and/or high blood pressure. Although 1.8 grams is a lot less EPA than 4 grams, the study participants, who were Japanese, already got more fish oil directly from the fish in their regular diet than Westerners do.So, exactly how much is 1.8 grams of EPA? Remember the cereal commercial that said “You’d have to eat four bowls of Raisin Bran to get the vitamin nutrition in one bowl of Total?” Well, you’d have to take 10 capsules -- five servings -- of an average over-the-counter fish oil supplement to get 1.8 grams of EPA. Want the full four grams? You’ll need to take about 22 capsules. And no one is recommending that. Studies that show benefits of high doses of EPA use prescription-grade pure EPA. Over-the-counter supplements have other ingredients, too, and they are not regulated and safety-tested like FDA-approved prescription drugs.
Omega-3 Supplements: Benefits, Risks, Side Effects
Omega-3 Supplements: Benefits, Risks, Side EffectsOmega-3 fatty acids are good for your brain and heart, but supplements may come with side effects.
“Some people take multiple, multiple capsules. But we don’t know that that’s safe,” says Manson. “Unless that’s under the guidance of a clinician, avoid mega-dosing.”If your heart’s already pretty healthy …In lower doses, fish oil may help the hearts of people who are in pretty good health. In a study of 25,871 adults over 50 with an average risk for heart attack, the ones who took 1 gram of fish oil -- containing 460 mg EPA and 380 mg DHA (just a little more than you might find in a daily OTC dose) -- every day for 5 years had a 28% lower risk for heart attack during that time. But they didn’t have a lower risk of stroke or death from heart disease. In fact, many studies that aimed to prove ordinary fish oil supplements lower risk for heart disease have failed to do so.If it’s not your heart you’re worried about …Aside from heart health, researchers have studied the effects of fish oil on many other conditions. But the benefits are clear in only a few of them. Fish oil might relieve symptoms of rheumatoid arthritis and lessen the need for pain medications, but only a little, the research shows. And in people who have a higher than average risk of getting Alzheimer’s disease because they carry the APOE ε4 gene mutation, high doses of DHA before symptoms of the disease arise may make having the condition less likely.As for other conditions, the benefits of fish oil are either nonexistent or unclear.
Can’t I Just Eat Fish?Absolutely. The best way to get most any nutrients, including omega-3s, is from your diet. In fact, several studies that show no benefits of fish oil supplements do show benefits of eating fish. For example, while fish oil supplements don’t lower the risk of heart disease, studies show that people who eat fish one to four times a week are less likely to die of heart disease than those who rarely or never do. Eating fish and shellfish may cut risk for stroke and for the loss of memory and thinking skills that can lead to dementia.
Vitamins and Minerals From A to Z
One type comes from animal sources of food. It helps you see at night, make red blood cells, and fight off infections. The other type is in plant foods. It helps prevent damage to cells and an eye problem called age-related macular degeneration. (But too much vitamin A can hurt your liver.) Eat orange veggies and fruits like sweet potato and cantaloupe, spinach and other greens, dairy foods, and seafood such as shrimp and salmon.
Vitamin B1 (Thiamin)
It helps your body turn food into energy. It's also key for the structure of brain cells. Legumes, like black beans and lentils, and seeds are go-to sources. Pork and whole grains are also good. Most people get enough thiamin from the foods they eat, but pregnant and breastfeeding women need a little more. People with diabetes tend to have low levels of it.
Vitamin B2 (Riboflavin)
You could get enough for the day from a good breakfast! It’s added to many fortified breads and grain products and also found naturally in eggs, asparagus and other green veggies, and milk. Your cells need it to work right, and it might help prevent migraines. (It gets its name from the Latin word "flavus" for yellow -- a lot of B2 will turn your pee a bright color.)
Vitamin B3 (Niacin)
This is a family of compounds that your body needs to turn food into energy and store it. It helps protect your skin and tissues, too, and may improve your cholesterol levels. Three ounces of canned tuna has nearly all you’ll need in a day. Or serve up some chicken, turkey, salmon, or other lean meats. You're vegan? Eat crimini mushrooms, peanuts, and peanut butter.
This vitamin plays a role in more than 100 different reactions in your body. Some research has shown that B6 may help protect against memory loss, colorectal cancer, and PMS. It’s found in many kinds of foods including leafy and root vegetables; non-citrus fruits like bananas, avocados, and watermelon; legumes; and fish, poultry, and lean meat.
Rev up before hitting the gym with a snack like a hard-boiled egg or cereal with vitamins added. B12 helps your body break down food for energy. Some athletes and trainers take supplements before workouts, but these don’t really boost your success if you're getting enough in your meals.
Despite claims made by some over-the-counter remedies, it doesn’t prevent colds. But once you have symptoms, drink orange or grapefruit juice to help yourself stay hydrated and feel better sooner. Your body must have vitamin C to help your bones, skin, and muscles grow. You'll get enough from bell peppers, papaya, strawberries, broccoli, cantaloupe, leafy greens, and other fruits and veggies.
This mineral helps concrete harden. Its strength makes it the building block for your bones and teeth. It's also key to make muscles move, including your heart. Get calcium from milk, cheese, yogurt, and other dairy foods, and from green vegetables like kale and broccoli. How much you need depends on your age and sex. Check with your doctor about whether you should take a supplement.
You only need a trace amount of this mineral, which is believed to help keep your blood sugar levels steady. Most adults easily get enough by eating foods like broccoli, English muffins, and garlic. You may see chromium supplements that promise to help you lose weight, but there’s no scientific evidence to back up those claims.
Like calcium, it keeps your bones strong and helps your nerves carry messages. It also plays a role in fighting germs. Careful time in the sun -- 10 to 15 minutes on a clear day, without sunscreen -- is the best source. Or you could eat fish such as salmon, tuna, and mackerel. There's a little in egg yolks, too. You can also get milk and sometimes orange juice with added vitamin D.
It’s something called an antioxidant, which protects your cells from damage caused by cigarette smoke, pollution, sunlight, and more. Vitamin E also helps your cells talk to each other and keeps blood moving. Sunflower seeds and nuts including almonds, hazelnuts, and peanuts are good sources. If you’re allergic to those, vegetable oils (like safflower and sunflower), spinach, and broccoli have vitamin E, too.
For moms-to-be, it's a must. It helps make DNA and prevent spina bifida and other brain birth defects. Asparagus, Brussels sprouts, dark leafy greens, oranges and orange juice, and legumes (beans, peas, and lentils) are rich in folic acid. Your doctor may want you to take a supplement, too.
You need it for blood clotting and healthy bones. People who take warfarin, a blood-thinner, have to be careful about what they eat, because vitamin K stops the drug from working. A serving of leafy greens -- like spinach, kale, or broccoli -- will give you more than enough K for the day. A Japanese dish called natto, made from fermented soybeans, has even more.
Your thyroid uses iodine to make hormones that control metabolism. The first symptom of a deficiency is usually a goiter, a lump in your neck caused by an enlarged thyroid gland. It’s rare in the U.S., largely because iodine is added to table salt. Other top sources include fish and seaweed. Too much iodine can be harmful though, and supplements interact with some medications.
When your levels are low, your body doesn’t make enough healthy red blood cells. And without them, you can’t get oxygen to your tissues. Women who are pregnant or have heavy menstrual cycles are most likely to have anemia, the medical name for when you don’t have enough iron in your blood. Keep up your levels with beans and lentils, liver, oysters, and spinach. Many breakfast cereals have a day’s worth added. Even dark chocolate with at least 45% cacao has some!
This mineral plays a role in making your muscles squeeze and keeping your heart beating. It helps control blood sugar and blood pressure, make proteins and DNA, and turn food into energy. You'll get magnesium from almonds, cashews, spinach, soybeans, avocado, and whole grains.
You may think of bananas, but green leafy veggies are a better source of this mineral. It helps keep your blood pressure in a normal range, and it helps your kidneys work. Levels that are too low or too high could make your heart and nervous system shut down. You should also watch your salt, because your body needs the right balance of sodium and potassium. Snack on raw cantaloupe, carrots, and tomatoes, too.
It does a lot of things, like fighting off infections and helping your thyroid gland work. Most Americans get enough from what they eat, including meat, bread, and eggs. Too much can cause brittle nails, nausea, and irritability. Just four Brazil nuts could put you at your daily limit for selenium!
Without it, you couldn't taste and smell. Your immune system needs it, and it helps cuts, scrapes, and sores heal. It may help you keep your sight as you get older. While you can get zinc from plant sources like sesame and pumpkin seeds, chickpeas, lentils, and cashews, it's easier for your body to absorb it from animal foods, such as oysters, beef, crab, lobster, and pork.
Reviewed by Carol DerSarkissian on 5/28/2018
What’s more, in studies that do show benefits of fish oil supplements, those benefits may be less in people who already eat plenty of fish and more in people who don’t get enough fish.“If there’s a rock-solid reason to supplement, then it’s to fulfill nutrient shortfalls for people who don’t consume enough fish,” says Duffy MacKay, ND, who is senior vice president for scientific & regulatory affairs at the Council for Responsible Nutrition, a trade association that represents dietary supplement manufacturers and ingredient suppliers.For example, take the study that showed that 1 gram of fish oil per day lowered the risk for heart attacks. That was true only for people who didn’t already eat fish. The researchers divided the study participants into two groups -- those who ate less than a serving and a half of fish per week, and those who ate that much or more. The ones who ate the least fish had a 19% drop in heart attack, stroke, and heart disease death, and a 40% drop in heart attack risk when they took the supplement.“They didn’t already have sufficient fish intake and weren’t already at a threshold where the supplements would have no additional benefit. If they were above 1.5 servings a week, they did not have a clear benefit,” Manson says.