Why Omega-3s Are So Important if You Have High Triglycerides
Omega-3s are like little doses of magic for your body, calming inflammation wherever they go. But they've also got another trick: When you get enough of them, omega-3s can help bring down your triglycerides. That's important because when your levels of this blood fat exceed 150 mg/dL, your arteries may develop a fatty buildup, upping your risk for heart attack and stroke.
Don't get us wrong: Your body needs some triglycerides to burn for energy. The key is finding that healthy balance. The omega-3 fatty acids EPA and DHA, which you can get from food, supplements, and medication if necessary, can help get you there.
The Magic of Omega-3s
On Chen, M.D., an interventional cardiologist at Stony Brook Medicine in Commack, NY, puts it simply: Of all the therapies available, “triglyceride levels are affected most by omega-3s.”
Studies over the years have shown that omega-3 fatty acids work better than any other food oil at bringing down high triglyceride levels; taken in very high, concentrated doses in the form of supplements or prescription medicines, they can lower levels by 25% to 34%, according to research in the journal Pharmacy & Therapeutics. You should always consider interactions with other medications.
How They Lower Triglycerides
When you consume fish oil or other foods with omega-3s, key essential fatty acids get incorporated into your cells where they counteract the chemical breakdown of fats (a process called hydrolysis). Those lipids would eventually be delivered to your liver for further processing. Less fat going to your liver means less fat being packaged into triglycerides for the body use later on.
Omega-3s generally help the heart in other ways, too, lowering inflammation, counteracting blood clotting, and minimizing the buildup of plaque inside the arteries.
Who Needs Omega-3s?
If your doctor says your sky-high triglycerides need to come down, chances are omegas are already part of the conversation. Or maybe your triglycerides aren't that high at all, and you just want to keep them that way.
But where to start? Can you just eat a lot of fatty fish? Or maybe do that, and take some fish oil supplements, too? And what about eating plant foods such as walnuts, flaxseeds, and canola oil, which contain a third type of omega-3 called alpha-linolenic acid (ALA). We've got the answers to those questions and more.
The Best Sources of Omega-3s
Starting with foods rich in omega-3s is a good jumping-off point for everyone, and fatty fish such as sardines, salmon, and herring lead the pack in concentrations of EPA and DHA.
The American Heart Association (AHA) suggests that all Americans eat two servings (4 to 6 ounces a serving) of fish a week. Yes, fish is heart-healthy because it controls triglycerides. But it also helps by lowering the risk for blood clots, lessening inflammation in blood vessels linked to heart disease, keeping blood pressure down, and lessening the risk of heart rhythm problems.
More About the Fatty Fish
The AHA recommends upping the two servings of fish to three if you have high triglycerides. But there’s a glitch with relying on fish alone to lower triglycerides: Eating loads of it increases the risk of exposing yourself to possible environmental contaminants such as mercury and PCBs.
To minimize this exposure, pass on the large fish such as shark, fresh tuna, and tilefish. Opt instead for fish lower in the food chain, which tend to be less toxin-laden: Wild salmon, sardines, bluefish, Atlantic mackerel, and herring.
Fished out? Well, that's ok because while getting your omegas from food is smart, dietary intake alone is almost never enough. You need very high concentrations to bring down triglycerides. Even adding in the plant-based sources of omega-3s won’t do the trick; they aren’t believed to be as effective as EPA and DHA in lowering triglycerides.
Many physicians suggest taking 2 to 4 grams of EPA/DHA per day in the form of a dietary supplement to lower high triglycerides. (Always check with your doctor before starting a new supplement though!)
What to Look for in a Supplement
Dietary supplements aren’t regulated in the U.S., so it’s impossible to know just what you’re getting when you pluck a bottle off the shelf—unless it has USP Dietary Supplement Verification, which means the product has been tested to verify it contains what the label says it does. Just look for the USP seal on the label.
Choose an over-the-counter omega-3 supplement that’s purified and contains EPA and DHA, says Robert Greenfield, M.D., a cardiologist at Memorial Care Heart and Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA.
More Supplement Tips
Unfortunately, the fishy burp-up that can come with taking over-the-counter supplements is, in some ways, unavoidable. Dr. Greenfield adds another caveat: “I always tell patients that if you open up the bottle and it stinks, it might be rancid.”
Another tip in the interest of palatability and to avoid nausea: Always take your omega-3 supplements with food. “You can also spread out your dosage over the course of the day instead of taking them all at once,” says Dr. Greenfield. “That will lead to less burping. Keep them in your fridge to make them more palatable, too.”
When a Prescription Pill Might Work Best
Sometimes, people have triglyceride levels that stay above 500 mg/dL regardless of how much fish they eat, supplements they take, or heart-healthy changes they make. In this case, the best bet may be a prescription medication containing highly purified forms of omega-3s from fish oil.
But again, it’s not for everyone; per the Food and Drug Administration, you’ve got to be at that 500 mg/dL level to get the script.
How Effective Can Prescription Fish Oil Be?
In various clinical trials, approved fish-oil formulations lowered triglycerides by 25% or more, though how effective they were depended a bit on the triglyceride level a person started with and the dose of medicine they took.
Basically, you’d be hard-pressed to take enough over-the-counter fish oil capsules (or eat enough fish!) to get the omega-3 load that appears in a prescription pill. Another perk to getting your omega-3s this way? “You won’t burp fish when you take one,” says Dr. Greenfield.