Does Fish Oil Lower Cholesterol? A Registered Dietitian Nutritionist Explains the Evidence
Medically reviewed by Elizabeth Barnes, RDNMedically reviewed by Elizabeth Barnes, RDNFish oil is one of the most commonly used supplements in the United States.It is a potent source of the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Studies suggest these nutrients may have numerous potential health benefits.In addition to supplements, DHA and EPA are also found in sardines, anchovies, mackerel, and salmon.
TakeawayIn the United States, the Food and Drug Administration (FDA) does not regulate supplements like prescription drugs. This means some supplement products may not contain what the label says. When choosing a supplement, look for third-party tested products and consult a healthcare provider, registered dietitian nutritionist (RDN or RD), or pharmacist.
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Does Fish Oil Lower Cholesterol?Studies suggest omega-3 fatty acids in fish oil supplements have helped reduce triglyceride levels.Still, fish oil’s effects on cholesterol levels are less established. Some of fish oil’s benefits may be attributed to its anti-inflammatory properties, which help protect against cellular damage.Lipids are fatty, wax-like substances and include cholesterol and triglycerides.High levels of lipids contribute to plaque build-up in your arteries and increase the risk of heart disease. It Lowers TriglyceridesTriglycerides are a type of fat the body uses for energy. High levels of triglycerides are associated with an increased risk of heart disease and heart attack. According to the American Heart Association’s scientific advisory statement, taking 4 grams daily of fish oil may reduce triglyceride levels by more than 30% after addressing underlying causes and changing diet and lifestyle strategies. Combined DHA and EPA or EPA-only supplements have effectively reduced triglyceride levels. However, a review suggested that DHA-only supplements may more effectively reduce triglycerides.DHA May Increase HDL (Good Cholesterol)High-density lipoprotein (HDL) cholesterol, also known as “good cholesterol,” helps the body remove excess cholesterol from the bloodstream.Higher HDL cholesterol and lower low-density lipoprotein (LDL) cholesterol levels are typically associated with a lower risk of heart disease and stroke. LDL cholesterol is also known as “bad cholesterol” because high levels are associated with a greater risk of heart disease.You may be considering increasing your HDL levels to help your heart health. However, increasing HDL cholesterol alone may be challenging.As mentioned earlier, fish oil contains both EPA and DHA. Some fish oil or omega-3 supplements may contain different amounts of these two nutrients.DHA-only omega-3 supplements have increased both HDL and LDL cholesterol levels in people with slightly elevated triglycerides. Generally, DHA-only supplements are not recommended to help with lowering cholesterol.EPA May Increase LDL (Bad Cholesterol)Fish oil supplements to lower cholesterol contain a mix of DHA and EPA or are just EPA.Although EPA appears effective at reducing triglyceride levels, evidence is less conclusive on the effects of EPA on LDL cholesterol. The American Heart Association's (AHA) scientific advisory statement concluded that EPA-only fish oil supplements do not raise LDL cholesterol levels among people with high triglycerides.However, fish oil supplements containing EPA and DHA may slightly raise LDL cholesterol.Another study observed a 15% to 36% increase in LDL cholesterol among individuals with very high triglycerides who took EPA and DHA-combined fish oil. However, the increase may reflect an increase in the size of the LDL cholesterol particle and not a change in circulating levels of LDL cholesterol.Smaller LDL particles are known to contribute to the accumulation of plaque in arteries.The magnitude of change in triglycerides may influence the effects of fish oil on LDL cholesterol.Significant triglyceride decreases may contribute to increased LDL cholesterol observed with fish oil supplements.Ultimately, additional research is needed to fully understand fish oil's effects on LDL cholesterol.What Is Fish Oil?Fish oil is extracted from fatty fish like sardines, salmon, mackerel, and herring. Fish oil supplements are generally encapsulated in a gel capsule. The main components of fish oil are DHA and EPA omega-3 fatty acids.EPA and DHA are long-chain fatty acids because their structure comprises multiple molecules. The AHA recommends 2 to 4 grams of DHA and EPA fish oil daily.Benefits appear to be dose-dependent, up to 4 grams daily. Moreover, the 4-gram dosage appears more effective than the 2-gram dosage in people with high triglyceride levels.Prescription fish oil contains 0.5 to 1 gram of omega-3 fatty acids per capsule. A therapeutic fish oil dosage is 4 grams daily. You can achieve four grams by taking four 1000 mg capsules.Studies notice improvements in triglyceride levels after 8 to 12 weeks of supplementation.However, there is no established length of time for taking fish oil.Instead, it should be taken under the guidance of a healthcare provider who can help determine how long you might need to take the medication.Bloodwork and your medical history also influence a fish oil regimen.
TakeawaySupplement use should be individualized and vetted by a healthcare professional, such as a registered dietitian nutritionist (RD or RDN), pharmacist, or healthcare provider. No supplement is intended to treat, cure, or prevent disease.
Is Fish Oil Safe for Me?Fish is a major, common allergen. Avoid fish oil if you're allergic to it or its components (parts).If you have a severe allergic reaction (itching, hives, shortness of breath), seek immediate medical attention.Potential Side EffectsFish oil may cause minor gastrointestinal-related side effects like the following:BurpingHeartburnNauseaConstipationDiarrheaFish oil capsules may also leave a fishy or unpleasant taste in the mouth. One more serious potential side effect of fish oil is atrial fibrillation (irregular heartbeat).The risk of atrial fibrillation may depend on your individual medical history.Higher doses of fish oil may increase the risk of atrial fibrillation.One analysis found a greater risk of atrial fibrillation with each one-gram increase in fish oil among people taking fish oil daily for nearly five years.Other research indicates a higher risk of atrial fibrillation with more than 4 grams daily in people with or at a high risk of heart disease.PrecautionsFatty fish is safe and encouraged during pregnancy.The Dietary Guidelines and the Food and Drug Administration recommend that people who are pregnant consume two to three servings of fish weekly. One serving is four ounces of precooked fish. Mercury can negatively affect fetal brain development.Salmon, sardines, anchovies, and Pacific chub mackerel are lower in mercury.King mackerel has a high mercury content. It is recommended that people who are pregnant avoid king mackerel. A lower dosage of fish oil is recommended during pregnancy to support fetal development and reduce the risk of preterm birth.Supplements should contain 250 milligrams (mg) of DHA, well below the therapeutic amount for cholesterol.People with very high LDL cholesterol should consult their healthcare provider before taking fish oil.Fish oils, particularly those containing DHA, may increase LDL cholesterol. Choosing a Fish OilIf you are considering taking fish oil to help lower cholesterol, talk to your healthcare provider about a prescription.Prescription fish oil supplements are more closely regulated than over-the-counter fish oil.The American Heart Association recommends prescription fish oil for people with elevated triglyceride levels looking to lower cholesterol. Alternative Ways to Lower Your CholesterolLifestyle and dietary modifications can lower cholesterol. Food, movement, stress management, medications, and supplements affect cholesterol.Fatty fish: Regularly consuming fatty fish rich in omega-3s reduces triglyceride levels and increases HDL particle size. The AHA recommends at least two servings weekly of fatty fish. The AHA estimates two 3.5-ounce servings of fatty fish provide, on average, 250 mg of EPA and DHA, a sufficient amount to reap heart-healthy benefits.Fiber: Whole grains, nuts, seeds, fruits, vegetables, and legumes are good sources of fiber. Fiber prevents the body from absorbing fat and cholesterol, reducing triglyceride and cholesterol levels.Oats: Oats contain beta-glucan, a fiber with cholesterol-reducing properties. Beta-glucan forms a viscous (thick) substance in the body that draws in cholesterol and takes it for removal. Consuming more than 3 grams daily of beta-glucan lowers LDL and non-HDL cholesterol significantly. A ½ cup serving of rolled oats provides approximately 3.8 grams of beta-glucan.Quit smoking: Smoking increases LDL and lowers HDL cholesterol, a bad combination for reducing cholesterol and supporting heart health.Movement: Exercise helps reduce triglycerides and increase HDL cholesterol. A collection of studies reported that a combination of strength and aerobic training had the greatest effect on lowering triglycerides and increasing HDL. Aim for 150 minutes of moderate-intensity aerobic exercise and two strength training sessions weekly.Mindfulness and meditation: Chronic stress may increase LDL cholesterol and lower HDL cholesterol. To manage stress, incorporate stress management techniques like meditation, mindfulness, and yoga into your routine.Prescription medications: Prescription medications like statins, bile acid sequestrants, and fibrates lower cholesterol by facilitating its removal from the body. They can be used alone or alongside fish oil and other dietary and lifestyle modifications.Supplements: Niacin is a B vitamin that may increase HDL cholesterol and lower triglycerides, LDL, and total cholesterol. Red yeast rice contains monacolin K, a molecule structurally identical to the medication lovastatin that may help lower cholesterol. However, supplements are not regulated and have their own side effects and safety concerns.It's important to speak with your healthcare provider about other options you may be considering.SummarySignificant evidence indicates fish oil lowers triglyceride levels. However, its effects on LDL and HDL cholesterol are less clear. The decision to take fish oil is nuanced and should be made with your healthcare provider.However, lifestyle and dietary changes like eating fatty fish twice weekly and adding more fiber to your diet are effective and relatively risk-free modifications to help reduce cholesterol. Read the original article on Verywell Health.
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