New cholesterol guidelines advise against fish oil and other supplements

More than half of U.S. adults take supplements, with heart health among the top reasons people report using them. The trend has prompted new medical guidance to advise against using fish oil or supplements to manage cholesterol. Previous versions of the cholesterol guidelines did not address dietary supplements.

These guidelines suggest that supplements do not meaningfully lower LDL, or “bad” cholesterol. They are not an effective alternative to prescription medications like statins. And, according to the updated guidelines, in some cases, taking fish oil may even worsen heart health.

Evidence Shows OTC Fish Oil Doesn’t Lower Cholesterol

Fish oil supplements are popular among Americans, with estimates suggesting that one in five older adults takes fish oil for their heart.

However, there is “no benefit” for using supplements to treat cholesterol or lower atherosclerotic cardiovascular (ASCVD) risk, according to Donald M. Lloyd-Jones, MD, ScM, FAHA.  He is co-author of the new cholesterol guidelines.

Multiple studies have shown that cholesterol-lowering drugs like statins are more effective at reducing cardiovascular disease risk than over-the-counter fish oil supplements.

“There is plenty of evidence, and it clearly indicates that supplements are a waste of time and money.  Both for treating cholesterol and for trying to lower risk for heart attack and stroke,” Lloyd-Jones said.

Fish Oil Might Even Worsen Heart Health

In some cases, fish oil supplements can raise LDL cholesterol levels and increase the risk of atrial fibrillation (AFib), or irregular heartbeats.

John P. Higgins, MD, a professor of cardiovascular medicine at McGovern Medical School at UTHealth Houston, said he has seen fish oil having these effects in his patients.

“The most common real-world problem is not dramatic toxicity, but false reassurance and treatment delay. Patients often believe a supplement is a ‘natural’ alternative to statins or other proven therapy.  That leads to LDL-C or triglycerides undertreated for years,” Higgins told Verywell.

Delaying proven treatments can increase the risk for a heart attack or heart failure in the future.

Prescription Fish Oil Is Still Recommended for Some Patients

The new guidance only applies to over-the-counter supplements. Prescription-grade fish oil, icosapent ethyl, is still recommended as a cardiovascular treatment for certain high-risk individuals.

Icosapent ethyl is a purified, high-dose form of the omega-3 fatty acid EPA that has been shown to work alongside statins.

Unlike prescription drugs, supplements are not subject to the same rigorous safety and effectiveness testing. OTC fish oil supplements may have impurities and are not effective for cholesterol management.

“OTC fish oil supplements have low levels of the important ingredient (EPA), and it would take at least 10 pills per day to get close to any potential benefit,” Llyod-Jones said.

Supplements Should Not Replace Diet or Drugs

Rather than loading up on supplements, try adding more fish to your diet. Seafood has been linked to a lower risk of stroke, potentially due to the other nutrients in the whole food source.

However, eating more fish also won’t guarantee perfect cardiovascular health. Genetics and family history influence cholesterol levels, and sometimes a statin is still needed alongside lifestyle changes.

And if a statin is recommended, fish oil supplements are not an effective alternative.  “Fish oil supplements cannot provide the proven benefits of statins.  Statins do reduce heart attacks and strokes in people with or at risk for ASCVD. In fact, you wouldn’t get much of anything at all, except for a thinner wallet, mild stomach upset, and belching that tastes or smells like fish, as often happens,” Lloyd-Jones said.

Source:  verywellhealth.com©

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