The research on essential fatty acids
Some major news channels have reported that fish oil’s importance in heart health has been debunked and that essential fatty acid (EFA) supplements are useless. These types of sensationalist headlines are unhelpful for many reasons, mainly because, well, they’re wrong. It’s been known for many decades just how important the right type and therapeutic ratio of EFAs is for many areas of our health. Let’s go behind the hype to better understand why and how EFAs are so important for health.
Limitations of the Cochrane review
Much of the media hype “discrediting” fish oil and other EFAs was taken from a review article published in 2018 by the Cochrane Collaboration. This group of researchers collates many different studies and performs statistical analyses to produce different health-based reports. In this particular review, they analyzed a conglomeration of studies of adults who were either given an omega-3 EFA supplement, provided with supplemental foods like nuts and margarine, and/or were simply given dietary advice. This analysis was therefore not designed to assess whether taking omega-3 EFA supplements might help prevent a heart attack in individuals at risk of heart disease.
Rather than relying on misleading headlines and quotes, let’s take an objective look into the Cochrane report:
- Very few of the people across the studies reviewed were instructed to take omega-3 in the form of fish oils; yet every nutritional therapist knows to recommend 1,000 mg of omega-3 EFA in the form of fish or krill oil, as well as eating oily fish three times a week, to those at risk of inflammatory disease including cardiovascular diseases.
- The report combined the findings of many differently-designed studies, all of which used different protocols and even measured different things – plant-based EFAs, fish-based EFAs, dietary recommendations, food provided to participants, supplements of variable quality and dosage, etc. In some of the studies included, participants were given nuts (which are high in omega-6 EFAs, not in omega-3) and even margarine (which we now know is not a health food). The Cochrane Review is therefore not focused on omega-3 EFA supplements (such as fish oil), as it encompasses too many different types of fatty acids. It is therefore difficult (and likely futile) to derive any conclusions based on this pooled data.
The Cochrane Review is therefore not focused on omega-3 EFA supplements (such as fish oil), as it encompasses too many different types of fatty acids. It is therefore difficult (and likely futile) to derive any conclusions based on this pooled data.
- The durations of the studies were mostly between one and two years. This is likely not enough time to thoroughly explore and understand the long-term effect of nutrients such as omega-3 EFAs.
- The article did not take into account the potential effects of prescribed medications; for example, statins increase the metabolism of omega-6 EFAs, in turn inhibiting omega-3 EFA bioactivity. The Cochrane review also did not take into account the different types of omega-3 supplements. The type of EFA and delivery method can make a big difference in terms of bioavailability and bioactivity, as we’ll discuss below.
Research on the benefits of omega-3 EFAs from fish oil
A study conducted over several years (a much more clinically appropriate length) compared the effects of giving patients with heart failure cholesterol-lowering statin drugs or omega-3 fish oil. This study concluded that omega-3 fish oil supplementation cut the risk of death or hospitalization, while statin drugs did not. Those taking 1,000 mg daily of omega-3 fats cut their risk of mortality by 9% and risk of hospital admission to 8% as compared to placebo. Those taking statins had no reduction in risk.
Omega-3 fish oil supplementation cut the risk of death or hospitalization, while statin drugs did not.
In another study, 57,972 Japanese men and women were followed by 12.7 years. The participants’ dietary intakes of fish and omega-3 EFAs were determined by food frequency questionnaires. The researchers found an inverse association between fish and omega-3 dietary intakes and cardiovascular mortality, especially for heart failure. In fact, those who ate fish and omega-3 EFAs were found to be at 18% to 19% lower risk of dying from cardiovascular disease, suggesting a protective effect.
Omega-3 fish oils show clear benefit for individuals with arrhythmia and in those with a history of a previous heart attack.,, In fact, a 2017 science advisory from the American Heart Association (AHA) concludes: “The recommendation for patients with prevalent CHD [coronary hear disease] such as a recent myocardial infarction [heart attack] remains essentially unchanged: Treatment with omega-3 PUFA [polyunsaturated fatty acid] supplements is reasonable for these patients. Even a potential modest reduction in CHD mortality (10%) in this clinical population would justify treatment with a relatively safe therapy.”
There are also numerous studies and reviews linking omega-3 EFAs to other areas of health, due to these fats’ effects in reducing systemic inflammation, including inflammation in the nervous system. For example, omega-3 fish oils have been shown to be effective in the treatment of depression, and to help calm anxiety and improve sleep quality. Fish oils are also crucial for development and function of the brain and nervous system, and for this reason pregnant women are often encouraged to eat fish and/or take fish oil supplements. Omega-3 EFAs also play an important role in memory and cognitive processes in people of all ages.,
Additionally, multiple studies have shown that omega-3 EFAs can help reduce triglycerides. Elevated triglycerides are associated with the development of atherosclerosis, CHD, and increased mortality in individuals with known CHD. Multiple studies have shown that omega-3 EFAs have a dose dependent effect of reducing triglycerides: at 1.8 g/day a reduction of 12% was seen, and at 4 g/d triglycerides were reduced by an impressive 45%.
In other words: the sensational headlines based on the recent Cochrane review are misleading, as they do not tell the whole story.
Choosing the best EFA products
Although choosing high-quality supplements is always important, discernment and smart-shopping is especially essential when it comes to EFA products
Omega-6 EFAs are important to health, but there can be too much of a good thing: the ratio of these polyunsaturated fatty acids (PUFAs) in our cells can affect the bioactivity of the crucial anti-inflammatory omega-3 EFAs. Westerners tend to eat more omega-6 EFAs in their diets, due to their prevalence in the food chain
But not all omega-6 EFAs are the same: arachidonic acid, a type of omega-6 EFA, is found in high levels in animal protein such as meat and egg yolks, and a high level of dietary intake of these foods is associated with increased inflammatory processes within the body.
However omega-6 EFAs from plant sources, including cold-pressed flaxseed oil, borage oil, and olive oil, contain omega-6 in forms such as gamma-linoleic acid (GLA), oleic acid (OA), and linoleic acid (LA) – all of which fight inflammation, nerve pain, blood pressure, heart disease, premenstrual syndrome (PMS), and even ADD/ADHD. These different types of plant oils, also found in seeds and nuts, also contain other beneficial nutrients, such as the omega-9’s and oleocanthals found in extra virgin olive oil. Oleocanthals are types of polyphenols that can reduce inflammatory markers such as TNKa, IL-1 and IL-6 in the body.
It’s worth noting, however, that heavily processed plant oils like sunflower oil can negatively impact our health. This is because the processing of these oils damages the delicate omega-6 EFAs they contain. This is just one of the reasons why reducing processed foods in the diet and taking omega-6 EFAs in the form of organic, cold-pressed oils is important for our health.
If we need both omega-3 and 6 EFAs then what ratio is best?
Well, this depends on your cellular EFA status and also your dietary intake of good quality EFAs (i.e. wild oily fish and organic, cold-pressed plant oils such as those from olive and flaxseed). Estimates of ideal ratios range between 4:1 to 2:1 omega-3:omega-6, and because of the low levels of oily fish and quality cold-pressed oils consumed by the majority of the population, many people need a helping hand in the form of quality supplements containing a careful blend of omega-3 fish oils and omega-6 from sources such as organic cold-pressed flaxseed, borage and olive oil.
Boosting oil bioactivity
It’s important to consider not only the types of oils that we’re eating, but also whether or not we can absorb them appropriately in the digestive tract. The digestion of fats can be a lengthy process, requiring not only the digestive enzyme lipase, but also sufficient levels of bile acids including lecithin. Low energy and poor health can impact these important digestive pathways.
A good quality digestive support supplement, such as one that includes both lipase and lecithin, may help digest EFAs and other important fats.
A good quality digestive support supplement, such as one that includes both lipase and lecithin, may help digest EFAs and other important fats, thus improving their bioavailability and bioactivity within the body.
- Omega-3 fatty acids, found mainly in oily fish, are important for reducing the risk of cardiovascular disease and supporting many other aspects of health.
- The right types of undamaged omega-6 EFAs (like GLA, LA and OA) are also important and are found in dietary sources such as cold-pressed oils, nuts, and seeds.
- An optimal balance of omega-3 and 6 EFAs can be achieved by manipulating the diet. For most people, this means aiming for an intake of three portions of oily fish per week and around 1 tablespoon of cold-pressed oil (such as flaxseed oil) per day.
- We can’t always get what we need from the diet, sadly, and chronic health conditions often require a little extra support. Looking for an EFA supplement that contains all the omega-3, 6 and 9 EFAs (including EPA, DHA, LA, OA and GLA) is therefore likely to help. Pairing these EFAs with lecithin and lipase (fat digesting enzyme) will further support the assimilation and bioactivity of these important oils.
So, is fish oil snake oil? Not even slightly.
Click here to see References
 Abdelhamid AS, et al. Polyunsaturated fatty acids for the primary and secondary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2018 Jul 18;7:CD012345.
 Mori TA. Marine OMEGA-3 fatty acids in the prevention of cardiovascular disease. Fitoterapia. 2017 Nov;123:51-8.
 Huang F, et al. Effect of omega-3 fatty acids supplementation combined with lifestyle intervention on adipokines and biomarkers of endothelial dysfunction in obese adolescents with hypertriglyceridemia. J Nutr Biochem. 2018 Nov 7;64:162-9.
 Fonarow GC. Statins and n-3 fatty acid supplementation in heart failure. Lancet. 2008 Oct 4;372(9645):1195-6.
 Yamagishi K, et al. Fish, omega-3 polyunsaturated fatty acids, and mortality from cardiovascular diseases in a nationwide community-based cohort of Japanese men and women the JACC (Japan Collaborative Cohort Study for Evaluation of Cancer Risk) Study. J Am Coll Cardiol. 2008 Sep 16;52(12):988-96.
 Tribulova N, et al. Omega-3 index and anti-arrhythmic potential of omega-3 PUFAs. Nutrients. 2017 Oct 30;9(11):1191.
 Cao Y, et al. Omega-3 fatty acids and primary and secondary prevention of cardiovascular disease. Cell Biochem Biophys. 2015 May;72(1):77-81.
 Siscovick DS, et al. Omega-3 polyunsaturated fatty acid (fish oil) supplementation and the prevention of clinical cardiovascular disease: a science advisory from the American Heart Association. Circulation. 2017 Apr 11;135(15):e867-84.
 Grosso G, et al. Omega-3 fatty acids and depression: scientific evidence and biological mechanisms. Oxid Med Cell Longev. 2014;2014:313570.
 Deacon G, et al. Omega 3 polyunsaturated fatty acids and the treatment of depression. Crit Rev Food Sci Nutr. 2017 Jan 2;57(1):212-23.
 Hallahan B, et al. Efficacy of omega-3 highly unsaturated fatty acids in the treatment of depression. Br J Psychiatry. 2016 Sep;209(3):192-201.
 Jahangard L, et al. Influence of adjuvant omega-3-polyunsaturated fatty acids on depression, sleep, and emotion regulation among outpatients with major depressive disorders – Results from a double-blind, randomized and placebo-controlled clinical trial. J Psychiatr Res. 2018 Dec;107:48-56.
 Lauritzen L, et al. DHA effects in brain development and function. Nutrients. 2016 Jan 4;8(1):6.
 Stonehouse W, et al. DHA supplementation improved both memory and reaction time in healthy young adults: a randomized controlled trial. Am J Clin Nutr. 2013 May;97(5):1134-43.
 Yurko-Mauro K, et al. Docosahexaenoic acid and adult memory: a systematic review and meta-analysis. PLoS One. 2015 Mar 18;10(3):e0120391.
 Hodis HN, Mack WJ. Triglyceride-rich lipoproteins and the progression of coronary artery disease. Curr Opin Lipidol. 1995 Aug;6(4):209-14.
 Sarwar N, et al. Triglycerides and the risk of coronary heart disease: 10,158 incident cases among 262,525 participants in 29 Western prospective studies. Circulation. 2007 Jan 30;115(4):450-8.
 Haim M, et al. Elevated serum triglyceride levels and long-term mortality in patients with coronary heart disease: the Bezafibrate Infarction Prevention (BIP) Registry. Circulation. 1999 Aug 3;100(5):475-82.
 Zhou Q, et al. EPA+DHA, but not ALA, Improved Lipids and Inflammation Status in Hypercholesterolemic Adults: A Randomized, Double-Blind, Placebo-Controlled Trial. Mol Nutr Food Res. 2019 May;63(10):e1801157.
 McKenney JM, Sica D. Role of prescription omega-3 fatty acids in the treatment of hypertriglyceridemia. Pharmacotherapy. 2007 May;27(5):715-28.