Are we reaching a consensus about fish oil?Print
The medical profession and FDA are recognizing the role of fish oil in reducing cardiovascular risks. Consumers have the option of fish oil prescription drugs or low-cost supplements. An omega-3 index blood test can enable people to optimize individual dosing of fish oil. The medical profession and the FDA are recognizing the role of fish oil in reducing cardiovascular risks.
“Consumption of omega-3 fatty acids may reduce the risk of coronary heart disease.”
The study observed several other benefits including:2
- Cardiovascular death reduced by 20%
- Fatal or nonfatal heart attacks reduced by 31%
- Fatal or nonfatal stroke reduced by 28%
- Urgent or emergency coronary revascularization reduced by 35%
- Hospitalization for unstable angina reduced by 32%
This fish oil is marketed to doctors as a drug that lowers triglycerides without raising LDL cholesterol.3 To the physician, this may sound appealing compared to a competitor fish oil drug that contains both EPA and DHA. What troubles us, however, is that patients taking the EPA-only fish oil drug (Vascepa®) are unlikely to take other fish oil supplements. This ignores the critical role of the DHA component of the omega-3 family on life-sustaining processes, especially brain and eye health.
Is A Consensus Being Reached?
Results from recent, large studies continue to validate the need for higher-dose omega-3 intake. As mentioned in the introduction of this article, and in the November 2019 edition of Life Extension® magazine, robust benefits were found when a high dose (4,000 mg/day) of an EPA-only fish oil drug (Vascepa®) was used. The study found a 25% reduction across a broad spectrum of cardiovascular disorders.2
In this same issue, we described why 1,000 mg a day of an EPA/DHA supplement (and only 2,000 IU/day of vitamin D) failed in its primary endpoint, but did yield meaningful risk reduction in several subgroups including:17,21
- 25% reduction in cancer deaths in the vitamin D group when the first two years of follow-up were excluded,
- 28% reduction in heart attack risk, and 50% reduction in fatal heart attack risk, in the fish oil group, and
- 22% reduction in angioplasty procedures (opening a narrowed coronary blood vessel, often with a stent) in the fish oil group.
Overlooked Role of Dietary Omega-3s
No one argues with the idea that eating two to three cold-water fish meals a week reduces cardiovascular and other disease risks. This is nearly universally agreed upon and accepted, including in the medical profession and among researchers.
Yet missing from virtually all research on fish oil supplements is each study subject’s dietary intake of EPA/DHA-rich foods. To put this into perspective, a 4-ounce can of wild salmon contains about 2,000 mg of total omega-3s providing about 1,800 mg of EPA/DHA.
So, a clinical trial using only 1,000 mg of supplemental EPA/DHA in people who regularly consume canned wild salmon might yield benefits because the total daily consumption of EPA+DHA is around 2,800 mg. On the flip side, individuals consuming typical Western dietary patterns that are nearly devoid of omega-3s may require far higher amounts of supplemental EPA/DHA (3,300 mg to 4,000 mg) to achieve the same results.
The significance of these differences cannot be overstated, both from a public health standpoint and on huge savings on fish oil drugs and supplements.
People whose diets already provide ample quantities of EPA/DHA will likely require lower potencies of fish oil drugs or supplements.
Yet a one-size-fits-all approach is the current protocol. The FDA now allows certain high-risk patients to be prescribed a 4,000 mg/day potency of an expensive EPA-only drug—but advises against the same potencies of lower-cost fish oil supplements!
How This Impacts You
The importance of achieving optimal EPA/DHA status cannot be overstated. It impacts a person’s risk of multitudes of disorders, many that are life threatening. Your blood ratio of omega-3 fats to omega-6 fats—which can be measured with the omega-3 index blood test—is an important determinant of overall health status.
The good news is that pricing keeps dropping for the omega-3 index comprehensive fatty acid blood panel. Results from this test can enable you to precisely determine how many fish oil capsules you need a day to achieve an optimal omega-3 index, which by most standards is over 8%. The recent study presented at the American Heart Association conference found meaningful cognitive benefits when omega-3-index scores were over 4%. I’ll describe soon how you can obtain low-cost omega-3/omega-6 blood tests that might enable you to reduce the number of fish oil capsules you take a day, saving you money over the long term.
Life Extension’s Position on Fish Oil Dosing
For many decades, we’ve suggested most of our readers supplement with about 2,400 mg of EPA + DHA each day from highly purified fish oil. We know most of you consume omega-3s in your diet by eating cold-water fish meals and/or via plant sources like walnuts, flax, and other foods. So, our typical reader may, on average, obtain over 3,000 mg-4,000 mg each day of EPA/DHA from their fish oil supplement plus omega-3-rich dietary components.
We caution, however, that not all people, and perhaps very few, convert plant-based omega-3s to EPA/DHA. This is what makes fish oil so important but presents a dilemma for vegans. People with stubbornly high triglyceride levels are advised to increase their fish oil intake to target a triglyceride blood level below 100 mg/dL. Based on published studies showing benefits with higher intake of EPA/DHA, more doctors are prescribing expensive fish oil drugs, often without considering an individual patient’s dietary intake of the omega-3s.
Supplementation with quality fish oil can cost about $300 a year whereas fish oil drugs can cost over $3,600 a year.
The Omega-3 Index Complete blood test includes the following measures:
- Omega-3 Index Percent (it should ideally be over 8%)
- Trans Fat Index
- Omega-6:Omega-3 ratio
- Arachidonic acid:EPA ratio
- Full fatty acid profile
Results from this blood test provide a guideline for dietary changes and fish oil supplementation for each person’s individual biochemistry. Those who obtain few dietary omega-3s in their diet may want to boost their supplemental fish oil intake over 3,000 mg a day, whereas those who eat lots of cold-water fish may reduce their supplemental dose below 2,400 mg a day.
While these common-sense approaches are obvious to me and Life Extension’s scientific staff, many hurried physicians are likely to stick with the labeled high doses of FDA-approved fish oil drugs, i.e. the one-size-fits-all approach.
Special Pricing: Omega-3 Index Complete Blood Test
We’ve recommended omega-3 blood tests for many years, but perhaps have not emphasized its importance enough.
With new studies validating the benefits of higher-dose fish oil, there is an even greater value to optimizing one’s fatty acid (omega-3 and omega-6) blood status.
Too Many Needless Heart Attacks
Growing consensus about fish oil, along with the new claims allowed by the FDA, will help enable more people to benefit from higher consumption of omega-3 fatty acids. The tragedy is that it took so long for the benefits of omega-3s to be widely recognized.
Cardiovascular disease remains the leading cause of disability and death in the United States, especially in elderly population groups. Armed raids by the FDA against those who recognized fish oil’s benefits in the 1980s resulted in countless numbers of cardiovascular events and astronomical medical costs for bypass procedures, stents and prescription drugs.
We look forward to science prevailing over the kinds of actions one might expect in an authoritarian, police state. This happened when doctors in Wuhan, China warned of a pneumonia epidemic in December 2019, but were silenced with threats of arrests for “spreading false rumors.”
This governmental censorship led to the deaths of hundreds of thousands of people worldwide from COVID-19 disease. FDA censorship of fish oil dating back to the 1980s may have led to similar tragedies.
Content Editor: Matea Kuzmanic
- Bhatt DL, Steg PG, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med. 2019 Jan 3;380(1):11-22.
- Manson JE, Cook NR, Lee IM, et al. Marine n-3 Fatty Acids and Prevention of Cardiovascular Disease and Cancer. N Engl J Med. 2019 Jan 3;380(1):23-32.
Manson JE, Cook NR, Lee IM, et al. Vitamin D Supplements and Prevention of Cancer and Cardiovascular Disease. N Engl J Med. 2019 Jan 3;380(1):33-44.