The People's Perspective on Medicine

Will Taking Quality Fish Oil Help Your Heart?

Research has confirmed that quality fish oil supplements can benefit cardiovascular health, mitigate autoimmune disease and possibly ease dry eyes.
Omega 3 fish oil capsules

Supplements have long been controversial, and fish oil is no exception. For years, knowledgeable nutritionists were enthusiastic about the benefits of marine omega-3 fatty acids, as fish oil is technically termed. Then several studies had disappointing results, and fish oil fell out of favor. Now, though, doctors may be reconsidering. Does quality fish oil have health benefits?

Q. I’ve taken fish oil successfully for years for lupus, osteoarthritis, dry eye, and cardiovascular benefits. Three different specialists recommended it. Even if they changed their minds about it tomorrow, their updated opinion wouldn’t alter my opinion on the benefits of fish oil.

I’ve found that quality matters for fish oil, as it does in many things in life. The amount and ratio of EPA and DHA are also important.

How Do Quality Fish Oil Supplements Affect Health?

A. A recent review of three large randomized controlled trials concluded that marine omega-3 fats (fish oil) can reduce the risk of cardiac complications and death from cardiovascular causes (Mayo Clinic Proceedings, Oct. 15, 2019).  One of these trials (REDUCE-IT) used a prescription pharmaceutical EPA product, Vascepa.

To summarize, the authors of this analysis concluded that 

“Marine omega-3s should be used in high doses for patients with CHD on statins who have elevated triglycerides and at about 1 gram/day for primary prevention for individuals who do not consume at least 1.5 fish or seafood meals per week.”

A different meta-analysis published in the Journal of the American Heart Association (Oct. 1, 2019) also concluded that fish oil supplements can reduce the risk of heart attacks and death from cardiovascular disease. In the thirteen trials analyzed here, higher doses of quality fish oil were linked to more protection.

Autoimmune Conditions Like Lupus or Rheumatoid Arthritis:

In addition, there is evidence that omega 3 fats have potential in treating autoimmune diseases like yours (Frontiers in Immunology, Sept. 27, 2019). Although your joint pain is caused by osteoarthritis, quality fish oil has beneficial effects in rheumatoid arthritis (Nutrition, Jan. 2018). 

Dry Eye Disorder:

You mentioned that fish oil helps ease your dry eyes. A systematic review of 15 studies suggests that supplements with omega-3 fatty acids may improve symptoms of dry eyes (Acta Ophthalmologica, Dec. 2017). While the scientific evidence is not perfect, it makes sense for you to continue with something that appears to be helping you.

How Can You Find Quality Fish Oil Supplements?

A few of the studies included in these analyses used pharmaceutical-grade fish oil, including icosapent ethyl (Vascepa) as mentioned above and omega-3 acid ethyl esters (Lovaza). The downside of these prescription products is price. 

If your physician does not prescribe one of these prescription quality fish oil supplements, you will want to choose carefully at the drugstore or online. We like to consult when we contemplate an important supplement purchase. In the latest analysis (Oct. 2019), the organization found that Kirkland Signature Fish Oil 1000 mg was a top pick. Another brand that it rated highly include Life Extension Omega Foundations Super Omega-3 EPA/DHA With Sesame Lignans & Olive Extract. For more information on these and other fish oil supplements, you may wish to purchase the report from 

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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  • O'Keefe EL et al, "Sea change for marine omega-3s: Randomized trials show fish oil reduces cardiovascular events." Mayo Clinic Proceedings, Oct. 15, 2019. DOI: 10.1016/j.mayocp.2019.04.027
  • Hu Y et al, "Marine omega‐3 supplementation and cardiovascular disease: An updated meta‐analysis of 13 randomized controlled trials involving 127 477 participants." Journal of the American Heart Association, Oct. 1, 2019. DOI: 10.1161/JAHA.119.013543
  • Li X et al, "Therapeutic potential of ω-3 polyunsaturated fatty acids in human autoimmune diseases." Frontiers in Immunology, Sept. 27, 2019. DOI: 10.3389/fimmu.2019.02241
  • Gioxari A et al, "Intake of ω-3 polyunsaturated fatty acids in patients with rheumatoid arthritis: A systematic review and meta-analysis." Nutrition, Jan. 2018. DOI: 10.1016/j.nut.2017.06.023
  • Molina-Leyva I et al, "Efficacy of nutritional supplementation with omega-3 and omega-6 fatty acids in dry eye syndrome: A systematic review of randomized clinical trials." Acta Ophthalmologica, Dec. 2017. DOI: 10.1111/aos.13428
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What about blue-green algae? This was recommended previously by People’s Pharmacy.

I buy Nature Made fish oil because it is approved by USP.

Can I take too much fish oil? I take 1000 mg per day, but still have dry eyes.

You could take more; some people take as much as 4000 mg per day. We don’t know if it will solve the dry eye problem, though.

Is flaxseed oil comparable and as good? If so, dose per day?

While flaxseed oil does contain omega-3 fats, they are not in the form our bodies utilize best and we don’t convert them efficiently. We’ve not seen a comparable dosing schedule.

How does fish oil compare with Flax seed oil for the ailments you mention in the article–Cardiac benefits, RA, and dry eye?

In one clinical trial of flaxseed oil for rheumatoid arthritis, 3 months of flaxseed oil produced no benefits:
There is some promising data on dry eye, however:

Have used Vitamin A palmitate for over 30 years now for adult acne, 4 pills a day. Even though I’m old I have major salicylate allergies, and it keeps my skin from breaking out if I eat a tomato or orange or other foods high in salicylates. I get this from an online lab. Was told to do this by a dermatologist in Atlanta many years ago, thank goodness he knew what to do instead of regular visits to another dermatologist who’d pick my skin and make it look worse.

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