When It Comes to Fish Oil, More Is Not Better | Chris Kresser
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When It Comes to Fish Oil, More Is Not Better

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Update: I now recommend Extra Virgin Cod Liver Oil from Rosita as my preferred cod liver oil product. For more information, read this article. You can purchase EVCLO here.

Article summary

  • The benefits of fish oil supplementation have been grossly overstated
  • Most of the studies showing fish oil benefits are short-term, lasting less than one year
  • The only fish oil study lasting more than four years showed an increase in heart disease and sudden death
  • Fish oil is highly unstable and vulnerable to oxidative damage
  • There’s no evidence that healthy people benefit from fish oil supplementation
  • Taking several grams of fish oil per day may be hazardous to your health

A new study was recently published showing that 3g/d of fish oil in patients with metabolic syndrome increased LDL levels and insulin resistance.

Unfortunately, I don’t read Portuguese so I can’t review the full-text. But this study isn’t alone in highlighting the potential risks of high-dose fish oil supplementation. Chris Masterjohn’s latest article on essential fatty acids, Precious yet Perilous, makes a compelling argument that fish oil supplementation – especially over the long-term – is not only not beneficial, but may be harmful.

This may come as a surprise to you, with all of the current media hoopla about the benefits of fish oil supplementation. Yet the vast majority of the studies done that have shown a benefit have been short-term, lasting less than one year. The only trial lasting more than four years, the DART 2 trial, showed that fish oil capsules actually increase the risk of heart disease and sudden death.

A 2004 Cochrane meta-analysis of trials lasting longer than six months suggests that the cardiovascular benefits of fish oil have been dramatically over-stated. They analyzed 79 trials overall, and pooled data from 48 trials that met their criteria. The only effect that could be distinguished from chance was a reduced risk of heart failure. Fish oil provided no reduction in total or cardiovascular mortality.

Too much fish oil can wreak havoc in your body

Omega-3 fatty acids are highly vulnerable to oxidative damage. When fat particles oxidize, they break down into smaller compounds, like malondialdehyde (MDA), that are dangerous because they damage proteins, DNA, and other important cellular structures.

A study by Mata et al demonstrated that oxidative damage increases as intake of omega-3 fat increases. The results of this study were summarized in the Perfect Health Diet, by Paul and Shou-Ching Jaminet:

oxidativedamage

Notice the clear increase in TBARS (a measure of oxidative damage of the LDL particle) with omega-3 fat. It’s important to note that this was only a 5-week trial. If it had gone on for longer than that, it’s likely the oxidative damage caused by omega-3 fats would have been even worse. This isn’t surprising if you understand the chemical composition of fats. Polyunsaturated fats (PUFA) are highly vulnerable to oxidative damage because they’re the only fatty acids that have two or more double bonds, and it’s the carbon that lies between the double bonds that is vulnerable to oxidation (as shown in the figure below):

diagram of chemical structure of EPA

Another thing worth noting, if you haven’t already, is that intake of saturated and monounsaturated fats does not increase oxidative damage by a significant amount. This is illustrated in both the table and the diagram above: saturated fats have no double bonds, which means they are well protected against oxidation. MUFA is slightly more vulnerable, since it does have one double bond, but not nearly as much as PUFA which has several double-bonds.

A randomized, double blind, placebo-controlled trial likewise showed that 6 grams per day of fish oil increased lipid peroxides and MDA in healthy men, regardless of whether they were supplemented with 900 IU of vitamin E. And consumption of fresh, non-oxidized DHA and EPA has been shown to increase markers of oxidative stress in rats.

Fish oil not as beneficial as commonly believed

To be fair, at least one review suggests that fish oil supplementation is beneficial in the short and even intermediate term. A recent meta-analysis of 11 trials lasting more than one year found that fish oil reduced the relative risk of cardiovascular death by 13 percent and the relative risk of death from any cause by 8 percent.

But the effect seen in this review was mostly due to the GISSI and DART-1 trials. They found that fish oil may prevent arrhythmia in patients with chronic heart failure and patients who have recently survived a heart attack.

However, there is no evidence that people other than those with arrhythmia and chronic heart failure benefit from taking fish oil or that doses higher than one gram of omega-3 fatty acids per day provide any benefit over smaller doses. And then there’s the rather disturbing result of the DART-2 trial, the only fish oil study lasting more than four years, showing an increase in heart disease and sudden death.

It’s logical to assume the effects of oxidative damage would take a while to manifest, and would increase as time goes on. That’s likely the reason we see some benefit in short- and intermediate-term studies (as n-3 displace n-6 in the tissues), but a declining and even opposite effect in the longer-term DART-2 trial (as increased total PUFA intake causes more oxidative damage).

The danger of reductionist thinking in nutritional research

The current fish oil craze highlights the danger of isolated nutrient studies, which unfortunately is the focus of nutritional research today. Kuipers et al. eloquently described the risks of this approach in a recent paper:

The fish oil fatty acids EPA and DHA (and their derivatives), vitamin D (1,25-dihydroxyvitamin D) and vitamin A (retinoic acid) are examples of nutrients that act in concert, while each of these has multiple actions(7,8).

Consequently, the criteria for establishing optimum nutrient intakes via randomised controlled trials (RCT) with single nutrients at a given dose and with a single end point have serious limitations. They are usually based upon poorly researched dose–response relationships, and typically ignore many possible nutrient interactions and metabolic interrelationships.

For instance, the adequate intake of linoleic acid (LA) to prevent LA deficiency depends on the concurrent intakes of α-linolenic acid (ALA), γ-LA and arachidonic acid (AA). Consequently, the nutritional balance on which our genome evolved is virtually impossible to determine using the reigning paradigm of ‘evidence-based medicine’ with RCT.

Interest in fish oil supplementation started with observations that the Inuit had almost no heart disease. It was assumed their high intake of marine oils produced this benefit. While this may be true, at least in part, what was overlooked is that the Inuit don’t consume marine oils in isolation. They eat them as part of a whole-food diet that also includes other nutrients which may help prevent the oxidative damage that otherwise occurs with such a high intake of fragile, n-3 PUFA.

It’s also important to note that there are many other traditional peoples, such as the Masai, the Tokelau, and the Kitavans, that are virtually free of heart disease but do not consume high amounts of marine oils. What these diets all share in common is not a large intake of omega-3 fats, but instead a complete absence of modern, refined foods.

Eat fish, not fish oil – cod liver oil excepted

That is why the best approach is to dramatically reduce intake of omega-6 fat, found in industrial seed oils and processed and refined foods, and then eat a nutrient-dense, whole-foods based diet that includes fatty fish, shellfish and organ meats. This mimics our ancestral diet and is the safest and most sane approach to meeting our omega-3 needs – which as Chris Masterjohn points out, are much lower than commonly assumed.

Some may ask why I continue to recommend fermented cod liver oil (FCLO), in light of everything I’ve shared in this article. There are a few reasons. First, I view FCLO as primarily a source of fat-soluble vitamins (A, D, K2 and E) – not EPA and DHA. Second, in the context of a nutrient-dense diet that excludes industrial seed oils and refined sugar, and is adequate in vitamin B6, biotin, calcium, magnesium and arachidonic acid, the risk of oxidative damage that may occur with 1g/d of cod liver oils is outweighed by the benefits of the fat-soluble vitamins.

So I still recommend eating fatty fish a couple times per week, and taking cod liver oil daily, presuming your diet is as I described above. What I don’t endorse is taking several grams per day of fish oil, especially for an extended period of time. Unfortunately this advice is becoming more and more common in the nutrition world.

More is not always better, despite our tendency to believe it is.

Note: As always, I’m open to discussion and dissenting views. But please don’t link to short-term studies on the efficacy of fish oil, because as I’ve explained in this article, it’s the long-term effects that we’re primarily concerned with. I’d be interested in seeing any studies longer than 2 years showing that 1) fish oil benefits extend beyond reducing arrhythmia in patients with chronic heart failure and patients who have recently survived a heart attack, 2) doses higher than 1g/d produce a larger benefit than doses of 1g/d, and (most importantly) 3) doses of >1g/d or higher do not increase the risk of heart disease or death

387 Comments

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  1. Too bad it is not safe to eat fish twice a week nowadays due to mercury and arsenic contamination of most seafood products.

  2. I started taking a natural Omega 3 product from a North-European producer, which balances the Omega 6:3 ratio 3:1 or lower, thanks to which I would consider myself cured from the uncurable. As I sceptic I also use blood tests from a internationally certified independent laboratorie. This is a simple dry blood-spot test for home sample collection. The laboratorie analyze the sample to determine your fatty acid profile as a reflection of your diet. The balance test identifies levels of 11 fatty acids in the blood with 98% certainty. You will learn your blood levels of omega-3 and your ratio of omega 6:3 for balance, plus receive a report to increase your health and dietary awareness. Test results will show whether your diet is balanced or unbalanced.
    Finally, if you hold a ratio 3:1 or lower then all life style diseases (skin, joints, asthma, allergies, diabetes 2, high blood pressure, thyroid, osteoporosis, cardiovascular diseases etc.) will start disappearing.
    My first test ratio was 8,4:1 at 27-th of February 2013, second after four months 3,4:1 and third a year later 1,6:1 and I`m OK- my psoriatic arthritis and psoriasis diagnosis code was L40.0(-).

  3. Hi, my father in law who suffers from bi-polar and also alcoholism has just recently been taking fish oils in large quantities. At first it helped him with his pain & swelling however then he started taking them all the time.
    As of 2 days ago he has been omitted to hospital and today was placed in the mental Ward. The 3 days leading up to this he had taken 100 tablets or more. One of those large buckets. It reacted massively with his mental state and made him very alert as if he had been given amphetamines. He had no control of his thoughts.
    I am very worried he will not recover.
    Does anyone know a way of flushing these omegas from your body or have any suggestions that may help?
    Thanks in advance

  4. I was taking fish oil supplements starting at age 51 and 3 years later i had a heart attack. i was doing very hard work digging up glue off of concrete for about 45 mins. when this happened. So I’m not sure why this could have happened to me. I have always kept my weight normal and used to walk all the time for exercise. I am now struggling some days, dizzy, feel not so great. Also, started taking coq10 after that HA. And cayenne pepper 90 heat units which it says you will never have a heart attack. Any advice?

    • At age 51 I’d suggest that you look at your lineage. Genetics in early heart attack play a huge part. I have seen entire families when +/- 2 years every male had a heart attack in the family history. Look backwards and perhaps you can find something useful. Also consider smoking, a huge factor

  5. The slightest hint of fish oil supplement in my multivitamin and my joints are in so much pain I can’t walk, use my hands or use my back…. Takes days for it to wear out of my system to get back to normal.

    • This has also just started to happen to me as I increased my Omega to 2400mg a day. My wrists are killing me

    • Deborah:

      Check to see if the product you are taking is in the form of ethyl esters. These are typical side effects reported for those taking Lovaza (omega-3 acid ethyl esters) that is composed of 465 mg EPA-EE and 375 mg DHA-EE per softgel.. Can you share with us what product you are taking and I will see if someone has analyzed your brand? Someone has information at omega-3-acid-ethyl-esters.com.

      Pixe

    • I recently started taking fish oil Natures Bounty 1000mg twice in the morning, now I have back pain as well.

      • I’ve been a 7 day a week gym rat for more than a decade. I’ve had my bouts with tendinitis and other injuries. I’ve never taken fish oil, though so many folks swear by it, I decided to start (with my mega foods 1 a day). Interestingly, I started to get terrible elbow pain shortly after I start taking it, with no explanation or change in workout… Rest didn’t help, nothing helped… I’ve now stopped the fishing for about 3 or 4 days now and miraculously, the pain is subsiding. Wondering if it can be contributed to the fishoil?

        • I have been experiencing this same problem! I started taking fish oils a couple months ago. My elbows became so inflamed my arms are going numb. So, I stopped taking them and it got better. Then, last week I thought I would try one more time. Same thing. I can hardly work without shaking my hands back awake and my back and feet are also aching. I thought I was losing my mind because fish oils are supposed to do the opposite. Glad to know I’m not alone 🙁

  6. I have been taking 1g of fish oil for over 20 years (this year algae oil). I have ADD and both these oils measurably improve my concentration, mood, anxiety, impulsiveness, knee pain, menstrual symptoms, skin and sleep. No other supplement has given the promised benefits that fish oil has. I hadn’t read a whole book cover to cover until I started taking fish oil in my 20’s, and I am unable to get through a paragraph within 10 days of going off the oil. Study or no study, I can’t function without the stuff. Too bad it seems to be causing me exercise induced chest pain in my 40’s despite excellent fitness. I don’t like hearing that omega 3 sources are either rancid or toxic but I would rather risk shortening my life span with toxicity (the entire food chain is toxic at this point) than stress about concentration related errors at work, impulse related errors in relationships and finances, limited exercise due to knee pain, poor sleep, older looking skin, many good books gone unread, not to mention killer cramps. The reason I’m impulsively and randomly blurting this expression out there is because I have tried to go off the oil for just about a week and once again I am sorely reminded I can’t live without that oil. If I was taking it, I would have had a second thought about impulsively babbling like this and stopped myself from sending it. Now I’m late, another thing the oil helps with.

    • Are you taking 1g each day? Also, do you have any hair loss? Just trying to figure if hair loss is a side effect…

    • I was googling about too much cod liver oil/ omega 3 oils. Why? My dad has been taking over the RDA for years due to arthritis and joint problems. He has always been super fit. He has lately been diagnosed with severe heart desease. This started with chest pain and respiratory problems. I could not understand how this could happen. No history of heart desease in the family. This is just speculation that there is a link but I can’t see any thing else. His diet had become poorer in older age eg moderate, chocolate, sugar, alcohol. However starting with cholesterol everything deteriorated with him doubling and tripling with the supplements. He never complained of arthritic aches and pain in 20 years since taking them but this news devastating! To the lady who can’t live without them. Check out that chest pain! It could be your heart!

      • I’m sorry to hear about your father. Can I ask how much was he taking and for how long? How old is he?

    • Denise:
      I have ADD too and the fish oil also helps with depression. Can u recommend a brand? Is Whole Foods Cold water fish oil okay? One capsule is recc and it had 180mg EPA and 120mg DHA.
      I have no clue how many mg is good.I’ve looked it up on line and still don’t have an answer.
      I don’t want to overdo it at all.
      Thank you very much.
      Amylee

      • Hi Denise,
        I have never had a problem with Andrew Lessman’s Maximum Essential Omega-3 Ultra Concentrate Of DHA And EPA Free Of Mercury And Contaminants. I take a few of his products and have never had a problem. He is the Founder of ProCaps Labs and you can find his products at HSN.com. I also buy his products at Amazon.com. Every so often he is on HSN and gives good discounts and free shipping. Hope this helps.

  7. My sons liver enzymes. Are sky high. Wonder and hope is that he takes 3000 to 4000 mg of fish oil per day.. He is 6’6 and is 260 pounds. And Dr suggested 1000 mg per day but he takes so much more than recommended hoping it would help is cholesterol would be better…. Could too much fish oil effect his liver enzymes?

    • I was a medic in the army. When we would prescribe medication, it’s stressed that they take ONLY ONLY ONLY the prescribed dose. Positive effects of a medication or supplement can only go so high. After the maximum prescribed dose is breached, benefits stop growing, and instead, side effects become more prominent.

      Taking a whole bunch aspirin doesn’t make the pain go away better, it just thins your blood to the point of your body not being able to stop yourself bleeding.

    • Sorry to say but the thing that will definitely help your son is to lose some weight. Fish oil won’t help as much as a good diet and exercise program. How do I know this? Because I was also overweight and tried supplements and all that crap and it didn’t work as good as losing that extra fat.

    • Yes, it can. My liver enzymes were also high when I was taking cod liver oil. That was the only possible explanation, they were never high before. I thought maybe it was the high vitamin A content that caused it because overdosing on vitamin A can raise liver enzymes.. They went back to normal once I stopped.

  8. You recommend 1g/d of cod liver oil, that is 1/5 of a teaspoon. Is it that you meant no more than 1 g/d of omega 3 fatty acids from cod liver oil? My cod liver oil bottle states it contains 1.4 g omega 3 fatty acids in 1 teaspoon of cod liver oil.

  9. How can you in good conscience make the claim that ” The only trial lasting more than four years, the DART 2 trial, showed that fish oil capsules actually increase the risk of heart disease and sudden death”

    The study clearly concluded that the increased association could have been due to a number of factors, including overcompensating or previous at-risk behavior. There is no causation whatsoever in this study, and your claim that fish oil capsules INCREASE the risk of heart disease and sudden death is a departure from your normally thoughtful analysis.

    • I agree. Chris’s article comes across as being biased to me. One of the issues Chris highlights is that fish oil easily oxidises, but there’s a simple remedy for that: buy fish oil which contains added Vitamin E (or other antioxidant) to stop it oxidising. Pharmaceutical grade fish oils usually come with antioxidants in them anyway.

      • I buy from Omega 3 innovations. I’ve heard the only issue with omega 3 oil is oxidation making it rancid which can cause adverse effects instead of being benificial. Peroxide level 0.10, anisidine level 1.60, these are important! Read up on this at http://www.omega3innovations.com.

  10. Not sure how old this article is. Just wanted to add that if you are taking fish oil then you should be taking Vitamin E with it. Taking fish oil long-term can cause a Vitamin E deficiency, which brings with it, many new problems. Many parents are giving their children fish oil hoping it will improve their ADD, autism, apraxia, etc. not realizing that fish oil can cause vitamin E deficiency and many of these children are already deficient in vitamin E to begin with. Also see Dr. Claudia Morris’ video regarding vitamin E and apraxia and autism.

      • Also we should not be using the term “fish oil”. The term “fish oil” is actually meaningless, considering the difference between the grades of fish oil available, for example, health food grade fish oil, and pharmaceutical grade. Pharmaceutical grade fish oil is much safer and can be taken in higher doses. Also, fish oil can cause a vitamin E deficiency in adults, after a decade or more. In children, however, this vitamin E deficiency can occur very quickly, especially when using a health food grade or rancid fish oil. People are buying jumbo health food grade fish oil for their one year olds hoping to cure autism, only adding to the oxidative stress to their child’s body. Any Omega 3 oil can have this effect, even hemp and flax oil. This can lead to ataxia, apraxia, eye twitches, and hemoblastic anemia.

        • There are some brands that have Vitamin E added into the fish oil as a natural preservative. Interesting that it’s also providing additional benefit. I’ll make sure to continue to use brands that add it in! Thanks!

    • Take a look at Life Extension article on fish oil Sept 2012 Take a look at Organic Facts. Accoring to the American Heart Association clinical trials have shown a decrease in cardiovascular disease by taking fish oil. It can reduce arherosclerosis as well. It reduces inflammation.

      There are several studies that show fish oil is beneficial. The Mayol Clinic recommends fish oil.

    • By Dr. Mercola

      Omega-3 rich fish oil is one of the most well-researched nutrients on the market. Its wide ranging health benefits have been repeatedly proven, and animal-based omega-3 fats are one of the few supplements I recommend for virtually everyone to improve overall health.

      It’s particularly critical for your brain health, and as the featured article and my interview with JJ Virgin shows, it may even help heal and restore brain function after a traumatic brain injury. Recent research also suggests that fish oil can help slow down age-related brain atrophy.

      According to the Centers for Disease Control and Prevention (CDC), some 1.7 million traumatic brain injuries occur in the US each year, making the prospect of utilizing fish oil very exciting. It’s inexpensive, and although it does act as a blood thinner, which could be contraindicated in some instances, its side effects are virtually all beneficial.

      According to leading omega-3 expert Dr. Barry Sears, there are currently seven cases in the medical literature describing the use of fish oil for traumatic brain injury—each one of them successfully so.

      16-Year-Old Defies Death Following Fish Oil Treatment

      The featured CNN article describes the tragedy and triumph of 16-year-old Grant Virgin, who suffered a wide range of injuries in a hit-and-run car accident. His injuries included skull fractures, spinal fractures, and bleeding throughout his brain. Doctors didn’t give his parents any hope for recovery. Instead of shrugging their shoulders in acceptance, his parents were indignant.

      “It’s like, how dare you not fight for my son’s life?’ said JJ Virgin.

      ‘It really took us… getting very aggressive and assertive to save our son’s life, because they weren’t going to do it… They told us to let him go,'” his mother told CNN.1

      From that moment forward — time and time again — they would go against doctor’s orders. That included trying unconventional, untested therapies — anything that might help Grant. One in particular involved giving him high doses of omega-3 fatty acids (found in fish oil). Fish oil is what the Virgin family believes ultimately — dramatically — altered his life course, and healed his brain.

      The Virgin family learned about fish oil from friends who had caught a previous CNN report about fish oil being used in cases of severe brain trauma. Grant’s mother, JJ Virgin, tracked down Dr. Barry Sears who, in 2006, consulted on the case of Randal McCloy—a miner who had suffered brain injuries from carbon monoxide.

      In that case, which was the first time fish oil entered the medical literature as a treatment for brain trauma, it was McCloy’s neurosurgeon who called on Dr. Sears’ expertise in a last-ditch effort to rescue his patient. As reported in the featured article:

      “‘There is no known solution, there’s no known drug, there’s nothing that we have really to offer these sorts of patients,’ said Bailes, co-director of NorthShore Neurological Institute in Evanston, Illinois, during a previous interview…

      The theory behind fish oil as a therapeutic intervention for traumatic brain injury is at once simple and complex. Simply stated, the brain’s cell wall is, in part, composed of omega-3 fatty acids.

      ‘If you have a brick wall and it gets damaged, wouldn’t you want to use bricks to repair it?’ said Dr. Michael Lewis, founder of the Brain Health Education and Research Institute. ‘By supplementing using (omega-3 fatty acids) in substantial doses, you provide the foundation for the brain to repair itself.'”

      Fish Oil—A Potent Anti-Inflammatory

      Omega-3 fats, which help fight inflammation throughout your body, also helps quell inflammation in your brain. After a traumatic injury, the brain inflammation that occurs can continue for long periods of time unless, as Dr. Sears states, “there’s a second response that turns it off.”

      Fish oil, it appears, can help do just that, when given in sufficiently high doses. After spending nine weeks in acute care, Grant was transferred into a rehabilitation hospital where he began receiving 20 grams of fish oil a day. (His parents had reportedly been sneaking fish oil to him while he was still in emergency care, but not at that high a dosage). Two days later, his mother received a late-night phone call from her son.

      “Forty-eight hours after receiving high-dose fish oil, Grant Virgin asked a nurse for a cell phone to call his mother, and proceeded to have a conversation with her. ‘Unbelievable,’ she said. ‘Unbelievable.’ Unbelievable, especially considering that was only two months after Grant Virgin’s parents had been told to ‘let him go,'” CNN writes.

      • How much fish oil-EPA/DHA is a recommended dosage? There are so many articles and my Dr. seems to think Fish Oil is a waste of money. Please let me know what you think. I am currently taking 1300mg of EPA and 850mg of DHA daily in one tsp. of concentrated fish oil equaling 4500mg. Thank you, Tracy

    • AS WE SEE IT
      How Much Fish Oil Is in Your Blood?
      By William Faloon
      By William Faloon

      William Faloon
      Evidence supporting the benefits of omega-3 fatty acids is so convincing that fish oil is the only dietary supplement the American Heart Association recommends people consider taking.1-3

      The American Heart Association has a longstanding bias against dietary supplements. So when they publish about the importance of consuming omega-3s from fish or supplements, this is a ringing endorsement from an otherwise slow-to-react scientific organization.

      Both the Life Extension Foundation and American Heart Association recommend omega-3 fats based on the published literature showing that those who consume cold-water fish or fish oil supplements have markedly reduced rates of heart attack and stroke. While these studies present persuasive data, a missing piece of the puzzle is how much EPA and DHA is required in the blood to protect against coronary artery disease.

      Measuring EPA/DHA in Heart Attack Victims’ Blood
      A landmark study was recently published on 1,059 patients admitted to the hospital because of heart attack or unstable angina (chest pain from coronary artery occlusion).4 Blood samples taken from each of these patients were evaluated for conventional cardiac risk factors and also EPA/DHA content.

      Compared to age-matched controls, the risk of unstable angina or heart attack was reduced by an astounding 62% for every 1.24% increase in whole-blood EPA/DHA. As the chart on this page clearly shows, the risk of having a serious cardiac event plummets as blood levels of EPA/DHA increase.

      This image depicts daggers aimed at a healthy heart. Any one of these daggers would kill if thrust deep into the heart. In the real world, however, aging humans suffer small pricks from the point of many of these daggers over a lifetime. Although none of the pricks by itself is enough to cause a heart attack, the cumulative effect of these dagger pricks (risk factors) is arterial occlusion and, far too often, angina or acute heart attack.
      Low Blood EPA/DHA: New Independent Cardiac Risk Factor
      When blood levels of EPA/DHA in these cardiac patients were matched against a control group, statistical analysis was able to show that low blood levels of EPA/DHA may be a new independent cardiac disease risk factor, at least in middle-aged patients.

      In this scenario, an “independent risk factor” means that even if other known promoters of coronary artery disease—such as cholesterol, LDL, and triglycerides—are in normal ranges, one’s risk of suffering a cardiac disease is still increased if blood levels of EPA/DHA are below the optimal range.

      In discussing the information gleaned from the study, the doctors noted that it supported earlier research published in the New England Journal of Medicine in 2002, showing lower blood levels of EPA/DHA in people who died suddenly from a heart attack, compared to controls.5

      Figure 1. Rate of Heart Attack and Unstable Angina Sharply Decreases as Blood Level of EPA and DHA Increases.
      Guarding Against All Known Promoters of Coronary Atherosclerosis
      Despite greater awareness of cardiac risk factors, heart attack is still the number-one killer of men and women.6 Sadly, heart disease and stroke are largely preventable, if people only had their blood tested and took the appropriate actions when proven cardiac risk factors fall out of optimal ranges.

      Few physicians understand that coronary artery occlusion can result from any combination of 14 different causes. While protecting against some of the underlying causes may delay its manifestation, heart disease will strike a large segment of the aging population that does not take corrective actions ahead of time.

      The good news is that most underlying causes of coronary artery occlusion can be detected by comprehensive blood tests.

      Based on the new finding that low blood levels of EPA/DHA may be an independent cardiac risk factor, we are adding “Low Blood EPA/DHA” to our evolving graphic of lethal daggers pointed at the aging heart. We are also factoring in the voluminous data showing that those who consume EPA/DHA in fish or supplements have significantly reduced coronary disease incidence.7-15

      The vivid graphic on page six makes it clear that aging coronary arteries are vulnerable to occlusion from a variety of insults. Based on these findings, it is difficult to comprehend why anyone over the age of 40 would not have their blood tested once a year to find out if their coronary arteries may be silently occluding (narrowing).

      Control Your Own Cardiac Destiny
      The annual blood tests recommended by the Life Extension Foundation are available at your doctor’s office, in hospitals, and through commercial testing laboratories.

      The most convenient way of obtaining the proper tests is to take advantage of the low prices offered by Life Extension’s nationwide blood-testing service.

      Just one phone call to 1-800-208-3444 enables an order to be placed for the comprehensive Male or Female Panel. Members are sent a computer-generated receipt that they take to a blood-drawing station that is often in their own neighborhood.

      No appointment is necessary. This means that members can pick a convenient time to have their blood drawn. The test results are usually mailed within 10 days. If there are any questions, Life Extension’s health advisors are available to answer them.

      Each year at this time, we reduce our everyday low prices. Until May 31, 2007, we discount all blood tests so that members can obtain comprehensive blood evaluations at a fraction of the price charged by commercial laboratories. For example, members save as much as 80% on the Male or Female Panels compared to what commercial laboratories charge.

      If this editorial saves just one life by detecting a cardiac risk factor in time, then it was well worth publishing. Based on the number of Life Extension members who are now having their blood checked, I am convinced our message is helping to extend the healthy life span of many human beings.

  11. “there is no evidence that people other than those with arrhythmia and chronic heart failure benefit from taking fish oil or that doses higher than one gram of omega-3 fatty acids per day provide any benefit over smaller doses. And then there’s the rather disturbing result of the DART-2 trial, the only fish oil study lasting more than four years, showing an increase in heart disease and sudden death.”

    My grandfather died age 56, whilst curling, from arrhythmia (his parents lived to 96 & 97). I believe the cause was diet having re-married, after first wife died—and new wife had a deplorable diet and died 22 years later at age 55 of brain cancer.

    The answer to arrhythmia may be magnesium, which must be constantly consumed as it is only stored in the small intestines and needs constant replenishment. Once magnesium is used up the electro-system immediately shuts down. There is no wiggle room when the Great Electrolyte Regulator is concerned.

    Three of my younger brothers have heart troubles, I am the second eldest and have no such problems having taken magnesium regularly throughout the day since 1974. My mum suffered potassium deficiency three times in 1974 and had to be rushed by ambulance to hospital. Upon research over six months I discovered the fact that magnesium is the great regulator and the consequences of its depletion. Mum died in hospital twenty years later when being assessed for independent living in the same hospital (an apartment setting for such assessment) but was not allowed to administer her own pills and was not allowed to bring her supplement of Magnesium with her. She died the third day of assessment from sudden electrolyte stress. Her two younger sisters died of the same deficiency years before, even though we had both warned them of the need for constant magnesium.
    Namaste and care,
    mhikl

  12. I’ve been studying Health/Nutrition for more than 30 years and pride myself on staying “current.” Again and again, however, it seems a case of, “Just when you thought it was safe to go back in the water…”

    I gave up krill (another highly touted oil) after learning about Fermented Cod Liver Oil on the WAPF site and have been using the FCLO exclusively for about a year and a half. Now I’m reading contradictory reports on this source as well (despite the long history of cod liver oil use, sans the fermented element). Questions have come up about how exactly is fermentation carried out when fish contains no sugars/starches–is the fish just left in vats to, well, rot? Not a pretty picture. Then I read about the use of lactic acid for the process, which makes sense, but for me, controversy such as this just puts me on edge.

    The problem is that I’m still not sure whether to take the FCLO, anticipating some future “oops,” about this supplement as well. The more I learn about most supplements, the more I am convinced (especially as a Paleo person) that our nutrition should come primarily from whole foods (as with native populations referenced here) where the full power and safety of the “isolated” nutrient is most assuredly dependent upon the synergistic effects of its “mother” — “the whole,” as they say, “is greater than the sum of its parts.”

    How so many of my relatives made it into their late 90s and even 100s by just eating regular old foods simply escapes me. Perhaps it was the lack of stress resulting from the relentless onslaught of “eat this/no! don’t eat this — take this, wait no, it can kill you…”

    • Hi Maggie! I love what you’ve said, and I couldn’t agree more with you. Thank you for sharing your insight and wisdom here- what a great conversation topic. I’m awaiting comments from Chris, as I am sure we all are.

      Do you have a blog? Could you share what it is, if so?

      Cheers!
      Stacey Rae

      • Hi Stacey Rae!

        Thank you for your kind words; I’m happy to see you agree. I’ve been advising friends and family (some might say ‘preaching,’) for years on steps to eating healthier (it’s gotten so that I have to avoid looking in shoppers’ grocery carts unless I’m at WF Market); most just spout out the familiar, deeply entrenched argument: “What’s the point? Everything gives you cancer anyway!” or, “Hey, you can’t live forever.” I try to get the point across that of course I know I can’t live forever, but that I for sure don’t want to be “dead” while I’m still alive!

        There is one friend of 13 years (male) I’ve managed to wear down, and he’s slowly but surely coming over to my side in some respects, although of course there are foods he’s just not about to give up; but, he, too gets frustrated when I catch him up on the “latest” studies that show this or that, some of which no longer show the same “this or that,” and I tell him that many study results have remained as constant as gravity and that this is why we have to align ourselves with the scientific method, with what evolution has taught us about who and what we are rather than blindly following the herd mentality that sprung from the not-so-scientific methods during the reign of Ancel Keys, et al.

        It sometimes seems easier for folks to reconsider their religious or political beliefs than it is for them to reconsider their nutritional ones .

    • Supplementation is never to first option. The right foods are the most important and even healthy foods can be harmful in large quantities. We promote the health benefits of eating fish. But too much fish can be toxic. We hope people understand the following two concepts:

      Don’t supplement if you can eat healthy foods.
      Also healthy foods can be dangerous if you exaggerate.

  13. Thanks for that thoughtful article. I just want to run this by you Chris:
    A well known lecturer and assistant professor in nutrition (who I won’t name here) at an American university explained to me at a recent workshop he was running here in the UK that he takes 25-30 grams daily of omega 3 fish oils! I was astounded. He does this because he had multiple autoimmune diseases inc Crohn’s and ulcerative colitis and joint disease diagnosed in his early 20s, which is what lead him to train in nutrition science. On this regime his IBD is fine and he can even eat a croissant when in Paris without a bowel flare up! This too surprised me but I guess just one croissant in a healed gut might not bring about sufficient fresh damage to become symptomatic. I don’t know if the fish oil he takes is EPA or DHA dominant, as I didn’t ask him. This chap is 37, very fit, very buff, very bright and with apparently boundless energy, and I think he has been on a very high dose of fish oils for some years. Your comments please!

  14. Would it be best to just take krill oil as that has natural antioxidant which supposedly counteracts the oxidation problem? be glad to hear peoples thoughts. thanks

    • In our opinion supplementation is never the first option. The right foods are the most important and even healthy foods can be harmful in large quantities. We promote the health benefits of eating fish. But too much fish can be toxic. We hope people understand the following two concepts:

      Don’t supplement if you can eat healthy foods
      Also healthy foods can be dangerous if you exaggerate.

  15. Oh lord, everything is bad for us! Can’t have juicers because of the sugar ,can’t have 8 glasses of water cos too much is bad for you and just dilutes urine, now we can’t have cod liver oil. I wish health “experts” would make up their minds whether something is or isn’t good for us to have. I’m so fed up of double standard studies on everything! Maybe we should just give up eating and drinking anything since it’s all bad for us. I mean if everything thats bad for us, is being told to us that is is good for us , then the companies need to come forward and tell us. But no they won’t because they love taking our money from us by telling us we need this that and the other.

  16. Three weeks ago I suffered a life threatening subacute subdural hematoma (brain hemorrhage) with a craniotomy required to drain the bleed and relieve pressure on the brain. It started with a fall in December, the admission CT showed three bleeds, one in December, one in January and the one that felled me in February. The surgeons at the hospital blame fish oil for my problem. I was on two 1000mg capsules per day for my psoriatic arthritis, one in the morning and one in the evening. Fish oil is an anti coagulant and blood thinner. Had I not been on fish oil the surgeons say the first bleed would have been a non-event, bleeding would have stopped naturally and been re-absorbed with me never knowing about it. Instead the bleeding steadily increased in severity over about 6 weeks. The surgeons in the Neurology ward told me that approximately 25% of brain hemorrhages they see are fish oil related and they are seeing people as young as 30 due to fish oil effects. I find these statistics staggering. The doctors have instructed me to stay off fish oil for life.

    I really wonder why these reports seem to suppressed, all we seem to see is glowing marketing hype for the benefits if fish oil and nothing of the possible negatives. Even a Google search will find little on side effects. I can only speculate on the reasons why.

    • Thank you for sharing that information. After a traumatic brain injury in my car last year, with no hematoma, but much brain swelling and heat, and an infection, I have been wondering why the area hasn’t healed faster. I take two triple strength fish oil caps a day, but I think I should stop after reading your experience. Concussions are common, but we don’t want to make things worse for ourselves.

      • Hi Lightfoot, I just want to suggest that you take coconut oil as it provides ketones which are brain/neuro protective in all traumatic brain injuries. Sapolsky say: “ketones are neuroprotective and don’t let the surgeons give you steroids as they make things worse”.

    • Wow, I hope you are doing well and that is a pretty shocking testimony. They should definitely look into this. The only time I have heard of this is with excessive dosage. It sounds like you are taking a normal amount, but possibly the others weren’t? Hence the need for some kind of controlled study.
      Are you eating an otherwise low fat diet which would make the omega-3 more concentrated? I can’t think of why else 2 gm of standard strength fish oil would cause this from what I have read previously! (they were standard strength I presume?)

      • Having had a cat with a nasal tumor that bled almost continuously, I find myself wondering what else you may have been taking that thins the blood…I mean nutrients. Several things I wanted to give Penelope to fight the cancer or reduce inflammation also thin the blood! It was frustrating, curcumen, flax oil, artemisinin come to mind, but there were others. I would google “Does so and so cause thinning of the blood” and find that several others had asked that question and that it did indeed cause thinning of the blood. I was thankful for Yunnan Baiyao!

    • And if you had been eating dandelion petals probably the docs would have said: “Ah…that was the cause.” I’m not being overly cynical either having spent time as an Adult ICU RN.s

      I say look to pubmed, nih, and research true peer reviewed documentation before making decisions.

      There is a good study on the effects of ethyl esters of omega 3 on rats genetically pre-determined to develop and die an early death due to systemic lupus. The amount fed was a % of food intake and would represent a lot of lovaza equivalent. There was a very significant increase in life-span of the rats fed the large amount of omega 3’s.

      But the rats were never queried about significant adverse effects, so where are we? For adverse effects check factmed.com. It is rarely conclusive but often gives insight.

  17. I have spent days and countless hours reading your posts and listening to your podcasts. I love your evidence-based approach and your accessible style.

    One request: I wish you would put dates on your articles, especially because of situations where your thinking on a subject like fish oils might evolve over time (e.g. Taking cod liver oil regularly vs. limiting it to times of need). It would be helpful to see the chronology of your thinking.

    • I’m so glad you brought that up; that’s the first thing I questioned when I began reading Chris’s article (I’m a big fan). It’s not just Chris who neglects to include dates–I find this to be very common and very frustrating since, naturally, we want to be sure that we’re receiving current, relevant information.

  18. This is a distressing development for me. I suffer from a nasty condition (Sjogren’s) that requires me to take 5-6 grams of fish oil per day. If I replace this supplementation with eating fresh salmon, I start ripping my corneas within a week or so. I already buy IFOS oil, keep it in the fridge…is there something else I can do to protect myself? I don’t seem to have another treatment option for my dry eyes.

    • Hi Beedee,

      I am not commenting with any clinical authority just a health and fitness enthusiast studying a science degree and focussing on nutrition.
      I have listened to and read some things by dr Rhonda Patrick (worth looking up) and she, as well as others advocates the consumption of vitamin E (be this from other whole foods: seeds or nuts or via supplementation) alongside the fish oil supplementation.
      Vitamin E reduces or protects against some of the inflammatory effects of the oxidation associated with fish oil supplementation as detailed above.

      I appreciate this hasn’t been grounded in much empiricism I was just browsing on my phone in a break and wanted to try and help. I hope my comments can serve as a platform for your own research or for others to assist. Either way I hope I’ve been helpful.

      Connor

    • hi beedee,

      I too have sjogrens and take around 3,000 mg daily to battle dry eyes. Do you take salagen? I take it and it also helps.

      • Hi, sorry to know you have dry eyes. It’s an irritating problem! I’ve relieved this problem by taking eye lutein that my friends have helped me bought from korea. You might wish to get it too since it works and is sold at affordable pricing. No idea if it’s available in your area. Let me know if u need help getting it.

    • Restasis has helped me SO much with my Sjogrens. I don’t know where I’d be without it! It takes about 4 months to work, but you will most probably notice a major difference!

  19. USANA actually have good quality of supplements such as ATP,
    Am’ I wrong ?
    Nutri-search is a good reference about supplements, right ?
    ATP is available since 2011 so they’re still not in the nutri-search guide.
    – sorry for my english –

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