Should we consider a fish oil supplement for our heart, joints, or mood?

 

Fish oil, which is often referred to as omega-3, ranks among the most sought-after dietary supplements. It is frequently advertised for its potential to safeguard heart health, enhance mood, minimize inflammation, and promote overall well-being.

However, how much of this is supported by research, and when are fish oil supplements truly beneficial?

A rich history

For centuries, humans have used fish oils.

Interest in this topic grew significantly during the 1970s when researchers analyzing the diets of the Inuit people uncovered omega-3 fatty acids and their benefits for heart health.

By the 1980s, fish oil capsules had begun to be sold as a convenient means of obtaining these beneficial fats.

What does fish oil contain?

Fish oil is derived from fatty fish species including salmon, sardines, tuna, herring, and mackerel. It is abundant in a unique kind of fat known as omega-3 polyunsaturated fatty acids (PUFAs), primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

These omega-3s are crucial for cellular function in our bodies. Each cell is encased in a delicate and flexible membrane that serves as a protective barrier: it safeguards the cell's materials, regulates movement in and out, and facilitates communication between cells.

While omega-3s do not form the membrane itself, they integrate into it, contributing to its composition. This incorporation helps maintain the membrane's fluidity and flexibility, enhancing its functionality, especially in tissues that require swift and accurate signaling, such as those in the brain and eyes.

Since our bodies cannot sufficiently produce omega-3s, it’s necessary to obtain them through diet or, on occasion, supplements.

How are fish oil supplements produced?

Once fish are harvested, their tissues undergo cooking and pressing to extract the oil. This raw oil is then purified and refined to eliminate contaminants, including heavy metals like copper, iron, and mercury.

During the processing phase, the oil may be concentrated to enhance its EPA and DHA levels.

Following purification, the oil is encapsulated in soft gel capsules or packaged as liquid oil.

Some supplements undergo additional processing to lessen the odor or eliminate the characteristic “fishy” aftertaste.

Fish oil and cardiovascular health

Omega-3 fatty acids are predominantly recognized for their implications in heart health, especially for decreasing triglycerides, which are fats in the blood that can elevate the risk of heart disease when their levels are high.

A study published in 2023 examined 90 clinical trials with over 72,000 participants and identified a nearly linear correlation between dosage and effect. This does not imply that "more is always preferable," but it was observed that higher dosages typically led to more significant improvements in heart-related risk factors.

The study concluded that to substantially reduce triglycerides (by 15 to 30 percent), one would need to consume more than 2 grams daily of combined EPA and DHA. This information is particularly relevant for individuals with pre-existing heart conditions, elevated triglycerides, or obesity.

It is essential to examine the label carefully. A fish oil capsule labeled as “1000 milligrams” typically indicates the total weight of the oil rather than the specific omega-3 levels. Generally, most capsules provide around 300 milligrams of the combined EPA and DHA, with the remainder consisting of other types of fats.

When taken in lower amounts, the impact on blood fats was minimal. This analysis indicated that low-dose fish oil might even cause a slight increase in LDL, often referred to as “bad” cholesterol, while only slightly affecting triglyceride levels.

In a trial conducted in 2018, a high-potency purified EPA formulation (4 grams daily) was tested on individuals who were already using statins to manage their cholesterol levels. Over the span of five years, this intervention resulted in the prevention of one serious cardiovascular incident (such as heart attack, stroke, or urgent medical procedure) for every 21 participants treated.

It is worth noting that the EPA in this study was a pharmaceutical-grade product available only by prescription, differing from typical fish oil capsules.

In Australia, fish oil products can be found in pharmacies, supermarkets, and health food shops. Some concentrated formulas are offered exclusively as “practitioner-only” supplements through healthcare providers.

The same purified EPA utilized in the 2018 study is marketed in Australia as Vazkepa, which is available only by prescription. It was included in the Pharmaceutical Benefits Scheme in October 2024, enhancing accessibility for patients at high risk.

For individuals who are otherwise well, the research supporting the effectiveness of standard fish oil supplements in preventing heart attacks or strokes is significantly less compelling.

What about their effects on arthritis and joint discomfort?

Fish oil possesses mild anti-inflammatory properties.

For those with inflammatory arthritis, such as rheumatoid arthritis, omega-3 fatty acids may alleviate joint soreness and stiffness in the morning.

However, these advantages necessitate consistently higher doses, typically around 2.7 grams of EPA and DHA each day. This translates to roughly nine standard 1000 milligram fish oil capsules, which contain 300 milligrams of EPA and DHA, taken daily for a period of at least eight to twelve weeks.

Can fish oil enhance mood?

Some research indicates that omega-3 fatty acids, especially those with higher levels of EPA, may help alleviate signs of clinical depression when used in conjunction with antidepressants.

A 2019 analysis of 26 studies involving over 2000 participants discovered a minor overall improvement, primarily with EPA-dominant supplements at daily doses nearing 1 gram. Products containing only DHA did not demonstrate significant outcomes.

However, this doesn’t mean that fish oil acts as a mood enhancer for everyone. For individuals without a formal diagnosis of depression, omega-3 supplements have not been consistently proven to elevate mood or deter depression.

What is the appropriate dosage?

For the majority, fish oil is considered safe.

Typical side effects may include a lingering fish taste, mild nausea, and diarrhea. Consuming capsules during meals or selecting odorless or "de-fished" options can alleviate these issues.

Prescription-grade products like Vazkepa (which is high in EPA) are generally well tolerated, though they might slightly raise the risk of irregular heartbeats (atrial fibrillation) and bleeding.

Up to 3 grams daily of combined EPA and DHA from supplements is usually regarded as safe for most adults.

Higher dosages for particular medical issues should be managed under the guidance of a healthcare provider.

Should you consider taking it?

The Heart Foundation advises Australians to consume two to three servings of fatty fish weekly. This intake would provide approximately 250-500 milligrams of EPA and DHA daily.

If you don’t consume fish, a fish oil supplement (or algal oil for vegetarians or vegans) can help fulfill your omega-3 requirements.

For those with heart conditions (particularly high triglycerides) or inflammatory arthritis, fish oil may provide additional advantages. However, the type of product and the dosage are important, so consult a health professional.

For most individuals, though, consuming two or three servings of fatty fish each week is the easiest, safest, and most nutritious method to obtain omega-3s.

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