Important note: Wild fish provides significantly more useable omega-3s than does farm-raised fish. Alaskan salmon is almost always wild, and Atlantic salmon almost always farmed. Fresh, wild fish is more expensive, but well worth every extra penny. A less expensive source is canned Alaskan salmon, sold next to the cans of tuna and crabmeat.This makes a great replacement or addition in tuna salad. Tip: Though the reason is unclear, adding a small amount of low-sodium soy sauce seems to boost the heart-healthy benefits of fish, according to a presentation at a November 2009 meeting of the AHA in Florida.
Worried about mercury and other pollutants found in fish? Don't. At this time, fish oil benefits outweigh the risks. But do remember that breaded, deep-fried fish can have the opposite effect and increase your risk of heart disease. The white fish used in most deep-fried dishes is low in omega-3s, and deep frying typically adds harmful trans fats. The batter and breading, too, are typically made with ingredients such as sugar and white flour.
Omega-3 Fish Oil Capsules
The American Heart Association suggests that people with heart disease take 1,000 mg (or 1 g) of fish oils daily. You can also take omega-3 fish oil capsules, in addition to eating fish or as an alternative. The capsules are soft gels, which are easy to swallow. Dosages vary, so read read the fine print on the label to ensure that you get approximately 1,000 mg daily of EPA and DHA combined — that is, approximately the amount in one 3-ounce serving of wild salmon (so essentially, you could choose each day either to eat a serving of wild fish or take fish oil capsules).
If your triglycerides are elevated, you can ask your doctor about a prescription form of omega-3s called Lovaza. Lovaza is approved by the FDA, and the dose is 4 grams (capsules) daily. Each capsule contains 465 mg of EPA and 375 mg of DHA. Fish oil products at pharmacies and health food stores are virtually identical, but if you have a prescription reimbursement, it could save you a significant amount of money to have your doctor prescribe it for you. Plus, prescription medications are regulated by the U.S. Food and Drug Administration so you can be assured of quality control. Note: Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician's care, according to the American Heart Association.
Finally, flaxseed oil supplements are commonly sold as a vegetarian source of omega-3s. But they contain the inactive precursor to EPA and DHA, and people convert only about 1 percent of the precursor to active forms. You'll do better with fish oils.
Controversy Hits Omega-3 Fish Oils
A 2012 study in the Journal of the American Medical Association raised doubts about the health benefits of omega-3 fish oils. The big question: Should you keep taking these popular supplements?
The report, by Greek researchers, was not a study in the conventional sense. The researchers conducted a statistical analysis of 20 published studies and found no benefits in terms of reducing the risk of heart ailments, stroke, or death.
Should one single study negate hundreds of human studies?
The analysis has its flaws. Fish oil dosages varied greatly, and in most cases were too low to have any significant health benefit. In addition, most of the studies analyzed lasted only one or two years — too short of a time to determine long-term health benefits. Furthermore, many of the 66,000 subjects had advanced cardiovascular disease, and about half were taking drugs (e.g., statins). As a result, there is a good chance that the drugs masked the benefits of fish oils.
The researchers even questioned the triglyceride-lowering effect of fish oils. This is striking because the FDA approved a prescription form of fish oils back in 2004 to lower blood levels of triglycerides, a risk factor for heart disease and stroke.
Many studies have shown that fish oils are a mild blood thinner, help maintain normal heart rhythm, and reduce inflammation.
While it's important that you talk with your doctor, the real benefits of fish oils relate to long-term prevention. Treatment becomes a much more complex medical issue.
- Lavie CJ, Milani RV, Mehra MR, et al. 2009. Omega-3 polyunsaturated fatty acids and cardiovascular diseases. Journal of the American College of Cardiology 54:585-594.
- Parker G, Gibson NA, Brotchie H, et al. 2006. Omega-3 fatty acids and mood disorders. American Journal of Psychiatry 163:969-978.
- Schaefer EJ, Bongard V, Beiser AS, et al. 2006. Plasma phosphatidylcholine docosahexaenoic acid content and risk of dementia and Alzheimer's disease. Archives of Neurology 63:1545-1550.
- Rizza S, Tesauro M, Cardillo C, et al. 2009. Fish oil supplementation improves endothelial function in normo-glycemic offspring of patients with type 2 diabetes. Atherosclerosis: doi 10.1016/j.atherosclerosis.2009.03.006.
- Mozaffarian D, Gottdiener JS, Siscovick DS. 2006. Intake of tuna or other broiled or baked fish versus fried fish and cardiac structure, function, and hemodynamics. Am J Cardiol 97:216-222.
- Mozaffarian D, Rimm EB. 2006. Fish intake, contaminants, and human health: Evaluating the risks and the benefits. JAMA 296:1885-1899.
- National Institute of Health. http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-fishoil.html. Omega-3 fatty acids, fish oil, alpha-linoleic acid. (Accessed February 26, 2010).
- Rizos EC, Ntzani EE, Bika E, et al. 2012. Association between omega-3 fatty acid supplementation and risk of major cardiovascular disease events: a systematic review and meta-analysis. JAMA 308:1024-1033.
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