Can fish oil supplements rich in Omega-3 lower your heart attack risk?

Dr Rajiv Bhagwat, interventional cardiologist, Nanavati Max Super Speciality Hospital, Mumbai on why you should have them only on the advice of your cardiologist..

The human body does not produce these Omega-3 fatty acids and so has to get them from rich sources like fish, namely mackerel, salmon, sardines and tuna.

Many of my patients with high cholesterol usually ask me whether taking fish oil supplements can reduce their cholesterol levels and whether these can replace drugs. While they cannot replace cholesterol-lowering drugs — and there are good and effective ones these days — we cardiologists recommend them on a case-specific basis only as a complementary treatment. In fact, there are strict norms on dosage and use as excess consumption can cause you harm.

What are fish oils?

These are nothing but Omega-3 polyunsaturated fatty acids (primarily eicosapentaenoic acid, EPA, and docosahexaenoic acid, DHA) which protect heart health. The human body does not produce these Omega-3 fatty acids and so has to get them from rich sources like fish, namely mackerel, salmon, sardines and tuna. Of these, mackerel is the best.

 

Its use became popular as studies showed how fish-eating communities, particularly the Inuits or the indigenous people in Greenland, reported very few cardiovascular diseases. In fact, the Inuits had very few heart attacks although their diet was mostly fat, making up to 40 per cent of their caloric intake. That’s because they had mostly salmon rich in Omega 3 fatty acids.

 

Those on a plant food diet have a milder version of Omega 3 fatty acid called alpha-linolenic acid (ALA). This is not as active in the body and must be converted to the two other forms, EPA and DHA. But the human body’s capacity to convert ALA is very limited. Only about five per cent of ALA is converted to EPA, while less than 0.5 per cent is converted to DHA. ALAs are found in chia seeds, walnuts, Brussels sprouts and flaxseeds.

 

What does Omega 3 do?

These fatty acids are important for regulating levels of blood triglycerides, which are the commonest type of fat in your body and are derived from foods like butter, oils, anything that is high calorie. They increase high density lipoprotein (HDL) or good cholesterol and keep blood platelets from clumping together as clots, thereby taking care of all risk factors related to heart health. They increase the plasticity of arterial walls and suppress inflammation, which is another trigger for heart disease.

According to the American Heart Association, consuming 2 to 4 grams of Omega-3 fatty acids per day can lower triglycerides by 20 to 40 per cent. But this dose is only to be prescribed by a medical practitioner for uncontrolled triglyceride levels to back up drugs, dietary correction and exercise. In fact, the REDUCE-IT trial demonstrated the efficacy of Omega-3 fatty acid in reducing stubborn triglyceride levels among people who had heart disease and who were also on powerful cholesterol-lowering drugs or statins. They reduced the risk of heart attack and stroke by 25 per cent and the risk of heart attack related death by 20 per cent among participants.

 

Are Omega 3 supplements safe enough?

They are safe when taken on the advice of the cardiologist. But they could be inappropriate for those on blood thinner medications and induce bleeding.

 

Also, while Omega 3 fatty acids are anti-inflammatory, care should be taken that they are balanced against Omega-6 fatty acids, which are pro-inflammatory and could negate the benefits of the first. A healthy diet contains a balance of Omega-6 and Omega-3 fatty acids. So the recommended ratio of Omega-6 and Omega-3 fatty acids is 2:1. This can go up to a maximum of 4:1 but not beyond. If there is excess Omega-6 in comparison to Omega-3 in the body, it can lead to inflammatory disorders.

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