Omega-3’s Update: What You Need To Know

By Dr. Laura Belus, ND

Omega-3’s Update: What You Need To Know
Omega-3’s Update: What You Need To Know / Heart Health

Article Highlights

  • Omega-3s are necessary for whole body benefit, especially the heart
  • The diet provides inadequate amounts of EPA/DHA for most people (even with regular fish consumption)
  • Fish oil supplements can supply therapeutic amounts of omega-3s to make daily dosing more feasible
  • Fish oil has a strong safety profile, is well tolerated by people of all ages and compatible with most medications

Omega-3 fatty acids have become increasingly popular in recent years. There is no shortage of information pertaining to its benefits, including heart health, brain function, and skin concerns. Over 20,000 journal articles exist on the topic, with over 250 published in the last 3 months alone. However, this information overload can leave the average person confused about why they should be consuming it, how much, and in what form (fish oil vs. food sources). More recently, there has been contradictory research published stating that omega-3 fatty acids may not be as beneficial as once thought. What information do you really need to know to make a decision? This article summarizes the facts about omega-3s: the latest research, why and how you can start benefitting from this nutrient in your diet.

What are they?
Omega-3 fatty acids are a group of lipid molecules that are derived from alpha-linolenic acid (ALA) which can be found in many plant foods such as flax seeds, hemp seeds and walnuts. The most commonly studied types are eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) which are subtypes derived from ALA in the body. The problem is, only about 8% of ALA turns into EPA and about 4% or less is converted into DHA making ALA supplementation a poor source of these important fatty acids. The main

direct sources of EPA and DHA are fatty fish such as salmon, herring and
sardines or a purified fish oil supplement.


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Why do I need them?
Omega-3 fatty acids are essential nutrients to human beings, meaning, we can’t make them ourselves and we need to get it from our diet. More importantly, balancing out the amount of omega-6 fatty acids that we consume daily (from vegetable oils, packaged goods) with omega-3s is a vital indicator of overall health in the body. The ideal ratio of omega6:3 should be around 4-5:1. For chronic diseases the goal ratio has been proposed to be as low 1-2:1. Unfortunately the Standard American Diet currently provides a ratio of 10:1 or greater. This further increases the need for proper dosing of omega-3 fatty acids to correct this imbalance. But what exactly are they good for? Simply put….everything! The heart, the body and the mind.

Heart Health
Perhaps the most studied benefit of omega-3 fats has been on cardiovascular health. This includes, but is not limited to, preventing and treating coronary artery disease (heart attack, stroke), lowering blood triglycerides and hypertension. Mechanisms of action include improving flow mediated arterial dilation regulating autonomic myocardial function (heart rate, rhythm). Put another way, having enough omega-3 fatty acids in the body allows cells to become “flexible”, they become more resilient against damage and transfer signals to one another more effectively.

At the heart of the matter
A 2011 meta-analyses investigation of randomized control trials (RCT) and prospective cohort studies (PC) have shown supplementing with omega-3 fatty acids reduces total coronary heart disease, with strongest evidence supporting reduction of coronary heart disease related deaths (RR:0.62-0.64, CI:95%). This means someone taking omega-3s is 62-64% less likely to die from coronary artery disease than a person who is not supplementing. Another analysis of 38 RCTS concluded that 1.2g of fish oil for 14 weeks lowered heart rate by 2bpm. Knowing that increased heart rate is an independent risk factor for sudden death, this translates to a risk reduction of 6%. Every beat counts. For those with pre-existing heart failure fish oil can help too. 1g daily improved ejection fraction (the amount of blood the heart pumps out with every contraction) and lowered total mortality by 8% after 4 years.


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More recently, a large prospective RCT, The Japan EPA Lipid Intervention Study (JELIS) examined over 15,000 patients with high cholesterol for 5 years with treatment of 1.8g of EPA (DHA was not included in treatment). Tracking blood levels of fatty acids revealed a 29% reduction in major coronary events during this period (p<0.0018 which means these results were really significant!).

Regarding blood lipids, omega-3s have been shown in numerous studies to reduce triglycerides (TG) and increase HDL (good cholesterol) by taking as little as 1g per day. Lowering both triglycerides and increasing HDL are predictors of cardiovascular health and are effectively managed with this nutrient.

Blood pressure can also be lowered with omega-3s. The mechanism behind this effect is likely due to its relaxing properties on blood vessels. A meta-analysis of RCTs found the average blood pressure decreases of 4.5mmHg systolic and 3mmHg diastolic for hypertensive individuals taking about 2g of fish oil daily for approximately 70 days. Blood pressure under control? Fish oil still worked (to a lesser degree) at lowering readings on those with high normal blood pressure.

Omega-3s improve Aspirin’s effects
A study of aspirin-resistant patients found that low dose, 81mg ‘baby’ aspirin plus 2g of omega-3s worked better than a larger 325mg dose. Adding the omega-3s did not increase bleeding and caused less stomach upset than the higher dose. This means adding an omega-3 supplement can improve tolerance of Aspirin in the body and allow a lower dose to do more good!

A Better Brain
Since the adult brain is made up of 40-60% lipids, the need for essential fatty acids like omega-3s are vital for its proper functioning. Maintaining good memory and a balanced mood can be helped with EPA/DHA.

Amounts of omega-3s ranging from 1-4g per day showed significant decrease in depressive episodes as early as four weeks after supplementation. Patients reported maximum benefit after 8 weeks regardless of whether or not they were taking anti-depressants.

Not surprisingly fish oil can also help preserve memory. Observational studies of people already taking fish oil supplements found that over a two year period they preserved their cognitive function and their brains avoided atrophying (shrinking) compared to the non-fish oil group. In particular, higher DHA seemed to have a greater memory-protective effect.



Inflammation of arthritis
Omega-3 fatty acids are known to have an anti-inflammatory effect throughout the body. They act as natural pain relievers by preventing the biochemical cascade of molecules that lead to redness, swelling and discomfort. After reviewing multiple studies, joint pain and morning stiffness due to rheumatoid arthritis were found to significantly decrease after 3 months of 2.5g daily fish oil supplementation.

Fish vs. Fish oil
The American Heart Association recognizes the benefit of omega-3 fatty acids as part of healthy diet. Eating fish (fatty types such as salmon) twice per week is recommended as each serving provides about 0.5-1g of EPA/DHA per 3oz. It is important to consider that most larger or farmed fish tend to have higher levels of environmental contaminants (mercury, PCBs), which means focus on eating a variety of fish sources to reduce overall toxic burden. But are the recommended two servings per week enough? Most benefit from omega-3s comes from a daily dose of at least 1g per day— the easiest way to ensure this would be through a quality fish oil supplement.

All fish oil are not created equal
The best sources of fish oil supplements are purified and tested for heavy metals and toxins usually by a third party. If this information is not available, always read the label to see the sources of fish used for the oil (small fish like sardines, herring are best due to lowest contaminant levels). Don’t forget to check the actual amount of omega-3s contained in one fish oil serving (for example: 1g of fish oil can contain anywhere from 30-90% EPA/DHA which means 300-900mg is actual omega-3s NOT the full 1g). It is the total amount of EPA + DHA that matters most.

Is it all good news?
Too good to be true is what some people have been led to believe after a recent article was posted stating fish oil has no benefit preventing deaths from coronary heart disease. However, the studies that showed no-relationship (or very little) were not conducted with enough ‘power’ to detect a reduction in death from omega-3 consumption. Simply put: when you consider the studies with no effect you look closer and see that there was, in fact, a benefit or the study contained flaws that prevented the results from being truthfully interpreted as ‘omega-3s are not effective in preventing death from cardiovascular events’. In a nutshell, plenty of good quality research exists to support the efficacy of omega-3 fatty acids. Truthfully, it is often under-dosed which may be why the ideal results are not seen in some cases.



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