Claire Corlett

Fish Food, Fish Tanks, and More
Fish Oil for Heart Disease: Nuances,  Quality and Controversies Explained (7)

Fish Oil for Heart Disease: Nuances, Quality and Controversies Explained (7)


– Fish oil is widely used in treatment of
heart disease. There are many evidence-based scientific trials
on fish oil in heart disease and hyperlipidemia. Can you discuss fish oil use?
Dr. Anton Titov MD Yes. It is absolutely unequivocal that fish oil
lowers triglycerides. The research is very strong that fish oil
can help to treat hypertriglyceridemia. Fish oil is equal to pharmaceuticals in lowering
triglycerides. There is even an FDA-approved version of fish
oil for treatment of hypertriglyceridemia. It is more controversial whether fish oil
can be used in secondary prevention of coronary artery disease. We have good drugs today for secondary prevention
of heart disease. We have aspirin, statins, ace inhibitors,
beta blockers. Before those became standard of care, fish
oil showed a very large benefit for reducing mortality after heart attack, reducing sudden
cardiac death, reducing myocardial infarction. Now, if someone is on all the best pharmaceuticals,
it’s not clear if giving fish oil gives additional benefit. It’s been looked at, but these clinical studies
have shortcomings, so we do not yet have conclusion about that. The good news is – fish oil, like many natural
therapies, has almost no downside to its use. We have to continually study fish oil to make
sure there are no adverse effects, But they [potential side effects] are pretty benign,
and our threshold for using fish oil is lower. If a medicine is very toxic or risky, you
need good evidence – before you give it to a patient – that it’s worth those risks and
toxicities to take it. But if a medicine is safe – of course, we
would love to have impeccable evidence of safety for all natural medicines – but if
we don’t, you probably don’t need to be as hesitant of using a natural medicine, because
the harms are either none or small. A study from Finland looked at benefits of
adding a little more fish to the regular diet. People who ate more fish had beneficial effects
on their cholesterol composition. Importantly, benefits were NOT in levels of
total cholesterol, but in the relative ratio of cholesterol and lipid fractions, which
could only be measured by research-grade methods. Cholesterol metabolism is very complex. Apart from HDL and LDL, there are many cholesterol
particles that are not routinely measured. So this study probably speaks to the benefits
of using more fish for heart disease prevention. I think you are right. This is one of the mechanisms by which fish
oil is beneficial for cardiovascular system. Fish oil changes a profile of LDL. When you use fish oil, sometimes your LDL
goes up a little bit because you are ingesting fish oil, which is a fat. If you eat enough fish oil, you can actually
increase your LDL levels. But if you fractionate the LDL particles,
you will see that the character of LDL particles changed. LDL particles became larger and more buoyant. We know that larger LDL particles are less
atherogenic than the small dense LDL particles. – So the details matter!
Dr. Anton Titov MD – That is right!

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