Fish Oil Supplements

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New Form OF SECONDARY CHD PREVENTION
Heart Association Associations
Advocates Fish Oil

BY MITCHEL L. ZOLER
Philadelphia Bureau

Chicago-- How much fish can you eat? Or would you rather take these capsules?

Those are questions that primary care physicians should start asking patients with documented coronary heart disease (CHD) now that the American Heart Association (AHA) has recommended that these patients consume about 1g of omega-3 fatty acids per day.

The AHA's new fish oil guidelines say that patients with documented CHD ideally should get their daily fish oil fix from
an approximately 3-ounce serving of a fatty fish such as salmon; herring, trout, or sardines. Somewhat leaner fish, such as canned tuna, halibut, and flounder also are fine but must be consumed in larger portions, according to the guidelines (Circulation 106[21]:2747-57 2002).

In a major departure, the AHA also said, for the first time, that a recommended nutrient could alternatively be consumed as a supplement-in this case, that would most commonly mean 1-g fish off capsules that are widely marketed and contain 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic add. To get their daily dose, patients should take three of these capsules.

"this is the first pill supplement ever, recommended by the AHA," William. Harris, Ph.D., said in an interview at the AHAs annual scientific sessions.

The AHA's nutrition committee found compelling evidence from controlled studies reported since 1999 that daily intake of about a gram of omega-3 fatty adds can significantly reduce the incidence of new CHD events inpatients with established disease. The committee also realized that many Americans would find it difficult to eat sufficient amounts of fish on a daily basis. Accumulated evidence also has shown that fish oil capsules provide a similar benefit, and that they appear to be safe, said Dr. Harris, coauthor of the recommendations and co director of the Lipid and Diabetes Research Center at the Mid-American Heart Institute, Kansas City, Mo.

The major downside to heavy fish consumption is that some species may contain significant levels of mercury or other environmental pollutants. Mercury intoxication is primarily an issue for children and women who are pregnant or breast-feeding, according to the guidelines. "For middle-aged and older men and for postmenopausal women; the benefits of fish consumption far outweigh the risks with-in the guidelines established by the PDA and the Environmental Protection Agency," the recommendations said.

The American Heart Association found
fish oil supplements to be safe, beneficial
for patients with documented heart disease

Fish oil capsules should be "high quality' and free of contaminants, the guidelines stated. Currently, there are few mechanisms in place that allow the public to be sure of these characteristics, Dr. Harris said:

The U.S. Pharmacopoeia has recently developed program that certifies nutritional supplements for purity and potency. Another possibility is that the AHA may start endorsing fish oil supplements. Until then, patients should look for 1-g fish oil capsules that each contain 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic add. This content provides some reassurance that the oil has been thoroughly processed and that contaminants have been removed, Dr. Harris said. A Norwegian company produce's an ultra purified 1-g capsule that contains 850 mg of omega-3 fatty acids, and it is now seeking a partner for U.S. marketing, he said. But these capsules will probably be more expensive than the ones now sold in the United States, which can retail for as little as 5 cents a capsule.

The new guidelines also recommended that people without cardiovascular disease eat at least two servings of fish a week. and also include oils and foods in their diet that are rich in a-linoleic acid, such as flaxseed, canola, and soybean oils; Walnuts and flaxseed. But fish oil supplements are generally benign, so there is no known down„ side if people who are in a primary prevention setting also use them, he said.

The recommendations also say that people who need to lower their serum triglyceride level-usually when the level exceeds 200 mg/dL--can accomplish this by taking 2-4 g of omega-3 fatty acids a day. For most people, the intake would need to be at least 3 g a day to have a triglyceride lowering effect, Dr. Harris said.

Physicians shouldn't misconstrue this recommendation as a knock against drugs such as fibrate or niacin, which are the established agents for lowering triglyceride levels. But omega-3 fatty acids have some efficacy for lowering triglycerides and are an option for patients, he said.

FDA APPROVAL

The information contained in these pages is for general use and knowledge and is not intended to be specific personal medical advice.

The activities and substances mentioned here all have potential negative consequences and you must always consult with your physician or health care provider before applying any of this information to your personal life. While all of the information conveyed on this site is from the medical literature, no guarantees of accuracy are implied or stated.