Eating Fish vs Fish Oil Supplements

Fish vs. Fish Oil Supplements - Which is Better?

For most people who are not at elevated risk (no congestive heart disease, normal blood pressure, normal cholesterol levels), eating two servings of fish per week may provide all the omega-3s you need. The federal government’s 2020-2025 Dietary Guidelines for Americans notes that nutritional needs should be met primarily from foods that contain vitamins, minerals, dietary fiber, and other substances that benefit health. Healthy dietary patterns are rich in potassium, which has been associated with lower blood pressure especially in people with hypertension.[1] Heart-healthy dietary patterns tend to be nutrient dense and rich in essential nutrients.² Vitamin and mineral supplementations should not be used as a replacement for a healthy dietary pattern. Sometimes fortified foods and dietary supplements may provide nutrients when you don’t get enough from food (e.g., vitamin D, calcium, vitamin B-12, folic acid). The Mayo Clinic, in a myth-busting article, also says that it’s better to get omega-3 fatty acids from your diet, rather than from a bottle of supplements.[2] In fact, there is a one in five chance that you will get an oil more oxidized than the recommended level in fish oil supplements.[3] In 2018, the National Institutes of Health, National Center for Complementary and Integrative Health, determined that for some health conditions, the evidence for benefits from seafood (fish and shellfish) is stronger than the evidence for omega-3 supplements.[4]

There are several possibilities for these results:

Seafood may provide enough omega-3s; more may not be better.
Other nutrients in seafood besides omega-3s may play a role in its benefits.
Some of the benefits of seafood may result from people eating it in place of less healthful foods.
There is evidence that people who eat seafood have generally healthier lifestyles.

The US Department of Health and Human Services, National Institutes of Health, Office of Dietary Supplements says that fattier fish have more the omega-3s (e.g., salmon and trout, and shellfish) – the ODS website provides a wealth of information about omega-3s including the recommended intake and a table displaying sources of dietary omega-3s and how many grams you get per serving.

The webpage Seafood Health Facts: Health benefits of omega-3s (a joint project by the Universities of Oregon State, Cornell, Delaware, Rhode Island, Florida, and California and the Community Seafood Initiative) has a list of the omega-3 content of frequently consumed seafood products. Another useful website is the US Department of Agriculture FoodData Central, where you can search the nutritional values of a large variety of foods.

February Is American Heart Month

The first American Heart Month was marked by President Lyndon Johnson in 1964 to focus on cardiovascular disease and allow experts to share best practices and broadcast the latest in CVD prevention.[5] Over the past 60 years, through research and education, the medical community’s prevention efforts have been successful in reducing the annual number of deaths. The most important preventive activities we can undertake are eating a healthy, well-balanced diet; maintaining an appropriate exercise regimen; and not smoking.

Current research on healthy diets points to vegetarian, pescatarian, and Mediterranean-type diets that are low in added sugars and refined carbohydrates and focus on whole foods (fruits, vegetables, grains), healthy fats (olive oil, avocado), and - if not vegetarian – includes seafood at least twice per week. For example, in its 2021 Dietary Guidance to Improve Cardiovascular Health, the American Heart Association emphasizes the importance of healthy dietary patterns throughout a lifetime to promote cardiometabolic health.

AHA guidance for heart health

adjust energy intake and expenditure to achieve and maintain a healthy body weight;
eat plenty and a variety of fruits and vegetables;
choose whole grain foods and products;
choose healthy sources of protein (mostly plants; regular intake of fish and seafood; low-fat or fat-free dairy products; and if meat or poultry is desired, choose lean cuts and unprocessed forms);
use liquid plant oils rather than tropical oils and partially hydrogenated fats;
choose minimally processed foods instead of ultra-processed foods;
minimize the intake of beverages and foods with added sugars;
choose and prepare foods with little or no salt;
if you do not drink alcohol, do not start; if you choose to drink alcohol, limit intake; and
adhere to this guidance regardless of where food is prepared or consumed.

Why fish is good for your heart

Two major benefits of eating fish and other seafood: it’s a good source of lean protein and an excellent source of omega-3 fatty acids.

Protein helps build and maintain your muscles, bones, blood, and other glands and organs. You also need protein to make hemoglobin, the part of red blood cells that carries oxygen throughout your body. Protein helps keep your immune system healthy, too. Fish is a healthier source of protein than red meat, which contains more saturated fat (which can be harmful to your heart).

Omega-3 fatty acids – found in fatty fish – are good for you.[6]^, [7]^{, [8], [9], [10], [11]} Your body can’t produce omega-3s, so you must get them from food. Fish have two omega-3s (docosahexaenoic acid [DHA] and eicosapentaenoic acid [DPA]) and plants provide some others (alpha-linolenic acid or ALA). There is strong evidence that omega-3 fatty acids can lower the level of triglycerides (a type of fat that can build up and cause blockages) in your blood. Omega-3s help keep your heart beating normally. Omega-3s may even help lower blood pressure.

Please Note:

Omega-3 dietary supplements may interact with the medications you take. For example, high doses of omega-3s may cause bleeding problems when taken with warfarin (Coumadin®) or other anticoagulant medicines. As always, you should talk with your health care provider about any complementary health approaches you use (including fish oil supplements). This article is meant only to be educational.

[1] https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines

[2] https://www.mayoclinic.org/dont-get-tricked-by-these-3-heart-health-myths/art-20390070

[3] https://www.theguardian.com/environment/2022/jan/17/revealed-many-common-omega-3-fish-oil-supplements-are-rancid

[4] https://nccih.nih.gov/health/omega3/introduction.htm

[5] https://www.acc.org/latest-in-cardiology/articles/2017/02/21/12/42/the-evolution-of-american-heart-month

[6] https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

[7] https://www.health.harvard.edu/blog/the-complicated-relationship-between-fish-oil-and-heart-health-2019120418399

[8] https://www.mayoclinic.org/drugs-supplements-fish-oil/art-20364810

[9] https://nccih.nih.gov/health/omega3/introduction.htm

[10] https://www.washingtonpost.com/lifestyle/food/most-dietary-supplements-dont-do-anything-why-do-we-spend-35-billion-a-year-on-them/2020/01/24/947d2970-3d62-11ea-baca-eb7ace0a3455_story.html

[11] https://www.mayoclinic.org/drugs-supplements-fish-oil/art-20364810