Heart Association endorses fish oil supplements

OB/GYN News,  Feb 1, 2003  by Mitchel L. Zoler

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CHICAGO -- How much fish can you eat? Or would you rather take supplemental 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 oil capsules that are widely marketed and contain 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic acid. To get their daily dose, patients should take three of these capsules.

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

The AHA's nutrition committee found evidence from controlled studies reported since 1999 that daily intake of about a gram of omega-3 fatty acids can significantly reduce the incidence of new CHD events in patients 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, remarked Dr. Harris, coauthor of the recommendations and codirector 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 within the guidelines established by the FDA and the Environmental Protection Agency," the recommendations said.

Patients should look for 1-g fish oil capsules that each contain 180 mg of eicosapentaenoic acid and 120 mg of docosahexaenoic acid. This content provides some reassurance that the oil has been thoroughly processed and that contaminants have been removed, Dr. Harris said.

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