Do the benefits of fish oil live up to its hype?

Fish oil has long been a convenient shortcut for anyone who wants to reap the health benefits of fish without actually eating fish. One of the main reasons for the established benefits of fish, especially fatty fish like salmon, for heart and brain health — including the developing brain during pregnancy and early childhood — is its omega-3 fatty acids.

For various reasons, only 2 in 10 Americans meet the recommendations — from the American Heart Association and other experts — to eat at least two fish meals a week. Some people don’t like fish, others like it fine but don’t know how to shop for it or cook it.

Some people avoid fish because they are allergic to it, or they eat a vegan or vegetarian diet, while others have concerns about sustainability or mercury content. I have patients who love fish and know how to cook it, but never do because their family doesn’t like fish and they don’t want to cook separate meals.

So for many people who aren’t eating fish yet want to get the benefit of omega-3s, fish oil capsules were a handy substitute. In fact, the fish oil industry was born out of the wealth of evidence about the health benefits of fish. However, recent research, including a study released last month in JAMA Cardiology, suggests that fish oil alone may not be all it’s cracked up to be.

The study was a meta-analysis (a “study of studies”) that pulled data from 10 large randomized trials involving nearly 80,000 people who were at high risk for cardiovascular disease. The authors found that omega-3 supplements were not associated with decreased risk of non-fatal heart attacks, stroke or death from coronary heart disease or other causes.

Nearly two-thirds of the participants were men, and the average age when they enrolled was 64, so these findings aren’t necessarily applicable to all people at all stages of life, but it is food for thought. The amount of fish oil used in the studies varied, and the study authors did recommend further research to assess if doses need to be higher than 1 gram (1,000 milligrams) per day — the amount in one typical serving of fatty fish — to have a positive effect.

On the other hand, we know that fish is rich in a number of nutrients, including selenium, vitamin D, protein — plus other fats that help us absorb omega-3s. It may be that the observed benefits from eating fish aren’t just due to omega-3s, but to the synergistic effect of all the nutrients in fish.

When you take a reductionist approach to nutrition, seeing a food as merely the sum of its component parts, you miss the big picture. For example, you can get vitamin C and potassium from fruits and vegetables, or from supplements, but fruits and vegetables also include a wealth of other vitamins, minerals and phytochemicals — including many that we haven’t even identified yet.

For generally healthy people who want to stay that way, the best bet is to simply eat fish — avoiding high-mercury predator fish like shark, swordfish, king mackerel and tilefish. For more guidance on making good fish choices, search for “FDA fish” to pull up guidance from the Food and Drug Administration, or visit SeafoodWatch.org.

Don’t know how to cook fish? Canned salmon and sardines are options, or visit WildAlaskaSeafood.com for lots of recipes and how-to videos. And don’t discount the unique benefits of plant-based omega-3s in foods like walnuts and chia, flax and hemp seeds — whether you’re vegetarian or not.

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