Last year I spent the year working towards and ultimately passed my Precision Nutrition Level 2 Certification. One of my favorite assignments was to research fish oil and decide for myself whether I would recommend it to my clients. In researching fish oil, I discovered many benefits both in relation to reducing cardiovascular disease markers as well as inflammation in general. Inflammation can impact our heart and vascular health as well as cause arthritis which can lead to joint pain and a loss of range of motion as we age.
While I am normally not one to encourage supplements prior to working with my clients toward a more ideal diet, fish oil is something that I recommend to most everyone now. Even in a perfect world, ideal levels of EPA and DHA are not easily achieved by diet alone. Below you can read some of the details of my findings which overwhelmingly support the use of fish oil. If you aren’t particularly interested in reading my research feel free to skip to the final paragraph to see which brand of fish oil we recommend at Ocean Blue Fitness and why.
When Fish oil is consumed, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are absorbed in the gastrointestinal tract and are transported to the liver. From the liver, EPA and DHA are released into the circulation as triglycerides in lipoprotein particles. EPA and DHA are then incorporated into cell membrane phospholipids throughout the body, particularly in the heart and brain, and are stored in adipose tissue as triglycerides. Consumption of fish oil increases the concentration of EPA and DHA in plasma lipids and membrane phospholipids and within about two weeks reaches maximum concentration. EPA can be metabolized to prostaglandin E3, which mediates inflammation and thrombosis. 1
Fish oil consumption impacts many elements that relate to our cardiovascular health including heart rhythm, cholesterol, blood pressure and heart rate. At typical dietary intakes, antiarrhythmic effects are the most commonly seen and may reduce the risk of sudden cardiac death and coronary heart disease. At higher doses, maximum antiarrhythmic effects have been achieved, but effects such as triglyceride lowering may take months or years of consumption to have an impact.2
Fish oil is known to increase concentrations of HDL and decrease the proportions of small dense LDL particles. In a meta-analysis of 70 randomized trials, fish oil supplementation reduced systolic blood pressure (BP) by 1.52 mmHg and diastolic BP by 0.99 mmHg. 2 These reductions are due to a systemic vascular reduction resulting from improved arterial wall function, and enhanced vasodilation.
In a meta-analysis of 30 randomized trials, fish oil supplementation (median dose 3.5 g/day, median duration eight weeks) reduced resting heart rate (HR) by 1.6 beats per minute (bpm). 3 This effect increased with more regular consumption and a reduction of 2.5 bpm was seen at 12 weeks. Heart rate decreases could account for some of the cardiovascular benefits associated with taking fish oil.
Conflicting evidence with regard to Fish oil seems largely related to dosing. Higher doses are associated with greater benefit and a minimum of 3g of Omega 3’s is needed to see a reduction in inflammation as well as other cardiovascular benefits. “To achieve these effects, higher doses of fish oil (>2 g/day) may be necessary, and it is not clear that lower doses produce substantial anti-inflammatory effects. Experimental evidence suggests that other metabolites of EPA and DHA, including resolvins, protectins, and maresins, may play crucial roles in active resolution of inflammation.”4
Risk versus Reward is always an important consideration when recommending a supplement. There appears to be very little that could go wrong due to an introduction of this dose of fish oil and while some have suggested caution in recommending fish oil to people on blood thinners it appears that even they would actually be at very low risk of bleeding. “Risk of bleeding was evaluated in nine trials including 2612 participants, including individuals taking asparin or warfarin. No bleeding was seen in four trials, and in the other five trials no consistent associations were seen between fish oil dose and bleeding risk.”5 The most common side effects of fish oil consumption are gastrointestinal disturbances such as nausea and even those are seen in only 4 percent of people at a 3 gram per day dose. If you have concerns about whether fish oil is right for you because you are on blood thinners or for any other reason, you should absolutely check with your physician prior to taking it.
The one fact that really stuck out for me during the course of my research was that correct dosing (3grams of EPA/DHA) was critical to achieving the desired results of reduced inflammation and reduced cardiac risk factors. As I began to look around at all the fish oil being sold I realized that the amounts prescribed on the bottles varied widely brand to brand and to get to the correct dose in many cases you would have to take more than was being recommended. These dosing issues also effected the cost of various brands because in order to take the correct dose you would have to purchase more than one vial per month. Fortunately, a friend told me about Stronger Faster Healthier (SFH) a brand of supplements made right here in Warren, Maine. I was thrilled to see a local business prescribing the correct dose and producing products that make taking the correct dose, easy and cost effective. SFH does not sell product directly to consumers but you can pick up a bottle at Ocean Blue Fitness where we carry both the flavored oils and a capsule version.
1. Masson S, Latini R, Tacconi M, Bernasconi R. Incorporation and washout of n-3 polyunsaturated fatty acids after diet supplementation in clinical studies. J Cardiovasc Med (Hagerstown) 2007; 8 Suppl 1:S4.
2. Dariush Mozaffarian, MD, DrPH. Fish oil and marine omega-3 fatty acids. UpToDate. Jun 2017
3. Miller PE, Van Elswyk M, Alexander DD. Long-chain omega-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid and blood pressure: a meta-analysis of randomized controlled trials. Am J Hypertens 2014; 27:885.
6. Wang C, Harris WS, Chung M, et al. n-3 Fatty acids from fish or fish-oil supplements, but not alpha-linolenic acid, benefit cardiovascular disease outcomes in primary- and secondary-prevention studies: a systematic review. Am J Clin Nutr 2006; 84:5.
7. Grujic D, Susulic VS, Harper ME, et al. Beta3-adrenergic receptors on white and brown adipocytes mediate beta3-selective agonist-induced effects on energy expenditure, insulin secretion, and food intake. A study using transgenic and gene knockout mice. J Biol Chem 1997; 272:17686.
8. George A Bray, MD, Leigh Perreault, MD. Genetic contribution and pathophysiology of obesity. Up To Date. June 2017.