The fishy business of heart health


A few years ago research on fish oil was so positive that it became the most popular supplement in the world. Now study results vary, so perhaps we need a more nuanced approach to both fish oil and fish.

Cardiologist and head of the new Victorian Heart Institute Professor Stephen Nicholls was recently interviewed by Norman Swan on ABC radio’s The Health Report.

Professor Nicholls was talking about his own fish oil research and its failure to demonstrate any improvement in heart health.

He looked at people in the high-risk category, all of whom take statins. But while statins can reduce LDL (aka ‘bad’) cholesterol, they typically don’t boost protective HDL cholesterol or lower another fat in our blood called triglycerides.

Nicholls wanted to find out whether big doses of fish oil were the answer.

They weren’t.

Meanwhile in Boston, a couple of high-profile women’s health and heart disease researchers from Harvard have been overseeing the world’s largest and longest trial of vitamin D and fish oil for the prevention of cancer and heart disease.

Unlike Nicholls’ group, the almost 26,000 people in their study didn’t have heart disease. They also used a standard dosage of fish oil — 1gram daily.

These women found that while fish oil didn’t reduce the risk of major ‘events’ (such as a stroke or fatal heart attack) across their entire population, it did make a difference in people with low fish intake.

And when heart attacks were considered separately from other conditions, fish oil appeared to reduce that risk by 28%, especially among African Americans.

That raises the possibility that fish oil may be beneficial for some people, including those who don’t eat seafood.

Whole foods are usually a better option than supplements, and seafood provides nutritional benefits that fish oil doesn’t, but as you probably know, even eating fish or shellfish has become complicated.

We have to navigate our way through conversations about overfishing, pesticide run-off and heavy metals in waterways and oceans, fish digesting plastic, farmed fish treated with antibiotics and fed pellets to colour their flesh, plus rebranding and mislabelling of fish so we don’t always know what we’re buying.

If it all starts to seem too hard, there are a few commonsense things to consider.

First, while we don’t have the capacity to predict whether fish oil might benefit us individually, if you take it, stick to a quality brand and the recommended dose.

Second, remember that what counts in your diet is a healthy balance of fats and oils that have been subjected to as little processing as possible. Omega-3 fats are just one part of that.

While the demand for fish has increased in recent times, perhaps in part because red meat has been demonised, bear in mind that there’s no credible research to indicate that eating pasture-raised meat is bad for our hearts. Most of us can choose from a variety of protein sources including meat, chicken, seafood, dairy, legumes and eggs.

When you buy fish make a thoughtful choice. Salmon is popular, but it’s also been referred to as the battery hen of the sea. Fresh salmon in Australia is farmed so make it an occasional rather than a frequent choice. There’s a lot more to choose from.

Finally, I mentioned earlier that the Victorian research was keen to see if fish oil would boost HDL cholesterol and lower triglycerides. It didn’t, but we know what does: exercise, a healthy unprocessed diet and losing a bit of belly fat.

Yet again the slow road and the big picture trump the quick and easy solution.

A shame, I know.


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