- Should you increase HDL, and how?
- 9 Effective Ways to Lower Bad Cholesterol and Boost Good Cholesterol
- 5. Nutritional Intervention
- Lowering Triglycerides and Raising HDL Naturally
- A cardiologist’s top 10 things to know about fish oil supplements
Should you increase HDL, and how?
Updated: June 19, 2019Published: July, 2017
Q: What are the best ways to increase HDL (good) cholesterol levels?
A: Before I answer that question, why bother to increase HDL cholesterol at all? Many studies have found that people with low levels of HDL are at increased risk for heart attacks, strokes, and other complications of arteries diseased by atherosclerosis: that’s why we call HDL the “good” cholesterol. Given that, you’d think that raising HDL levels would reduce a person’s risk for atherosclerosis. Unfortunately, despite a lot of research, we don’t yet know if that’s true, nor how best to raise HDL levels.
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Why is HDL helpful?
LDL causes plaque build-up, and, over time, can lead to heart attack and stroke. HDL works in your bloodstream like a scavenger or cleaner. It removes the bad LDL cholesterol from the blood, taking it to your liver to be excreted.
It’s critical to keep your LDL low — ideally, under 100. (Your doctor may want to keep it even lower if you’ve had a cardiac event.) You also want to keep your HDL high — ideally, 50 milligrams per deciliter of blood or higher. (The normal range is 40 to 59 milligrams per deciliter.)
When HDL levels dip below 40 milligrams per deciliter, your risk of heart disease rises.
What can you do to keep HDL high?
“Although medications can increase HDL cholesterol, research has shown that they do not necessarily alter your risk of heart disease,” says Dr. Wassif. “So we focus on LDL cholesterol reduction and recommend lifestyle changes.” The American College of Cardiology and American Heart Association recommend:
A healthy, well-balanced diet. Eat a Mediterranean-style diet rich in vegetables, fruits, nuts, whole grains, and lean vegetable or animal protein and fish. (Limit trans fats, processed meats, refined carbs and sweetened beverages.)
Regular exercise, such as walking. Get at least 150 minutes of moderate-intensity physical activity per week, or 75 minutes per week of vigorous-intensity activity.
Maintain a healthy weight, or lose excess pounds if needed. Besides improving your diet and exercise habits, a comprehensive plan may include lifestyle counseling for stress, sleep hygiene and other individual challenges you face.
Don’t smoke. If you smoke, individual or social support groups are recommended while trying to quit to increase your chances of success.
Manage your blood sugar. If you have type 2 diabetes, a healthy diet and exercise are crucial, along with any medications your doctor may recommend.
Aim for a blood pressure of < 130/80 mm Hg. Get the proper amount of good-quality sleep, follow a low-sodium diet and meet the recommended exercise guidelines.
Start by taking these small steps to change your lifestyle. They’ll help you boost your HDL, making it easier for your “bloodstream’s cleaner” to do its job.
9 Effective Ways to Lower Bad Cholesterol and Boost Good Cholesterol
There seems to be no escape from pollution; it’s getting only worse every year. The urban population is most effected as they constantly need to deal with heavy traffic exhaust, among other factors. As such, the number of pollution related health problems are also spiking up alarmingly across the globe. According to a new done by Griffith Bell of the University of Washington School of Public Health in St. Louis, US, people who live in polluted areas, near sources of heavy traffic exhaust, may be at higher risk of heart disease because the fine particles in this type of pollution lower levels of “good” cholesterol needed for healthy blood flow, as reported by Reuters.
Cholesterol is divided into ‘the good’ HDL cholesterol, ‘the bad’ LDL cholesterol and ‘the ugly’ cholesterol. If the levels of normal fat and triglycerides in the blood are high, then the levels of ugly cholesterol are also high. Good HDL cholesterol is required in the body because they not only work against bad cholesterol, but also keeps a check on heart health by lowering levels of triglycerides which are dangerous, plaque causing fats. The researchers studied 6,654 adults and found people exposed to higher levels of fine and ultrafine particles in traffic pollution tended to have lower levels of HDL cholesterol in their blood.
“However, this was a fairly small effect – it wasn’t a dramatic lowering of HDL – so I don’t think this is a huge cause for alarm beyond what we already know about the dangers of air pollution,” said lead study author Griffith Bell.
How to Manage Cholesterol
Apart from external factors like pollution, your diet can help in a big way to manage your cholesterol. Here are some tips –
1. Eat Beans and Pulses
According to a study, eating one serving a day of beans, peas or lentils can significantly reduce “bad cholesterol” and therefore the risk of cardiovascular disease. Eating one serving a day of pulses, people can lower LDL (‘bad’) cholesterol by five percent. Pulses have a low glycemic index (foods that break down slowly) and tend to reduce or displace animal protein as well as “bad” fats such as trans fat in a dish or meal.
Strawberries can dramatically reduce the levels of bad cholesterol and triglycerides, reveals a research study. A few volunteers were asked to consume half a kilo of strawberries a day for a month to see whether it altered their blood parameters in any way. By the end of the month, their levels of bad cholesterol and triglycerides had reduced significantly, according to the analyses conducted by Italian and Spanish scientists. Strawberries are known for their bioactive compounds or antioxidants that keep a check on cardiovascular diseases.
3. Say Goodbye to Sugary Drinks
Reducing the intake of sugary drinks by one serving a week for an year can increase “good” cholesterol levels in children, a new study done by researchers from Tufts University. The results also showed that a higher intake of sugary drinks was associated with a higher triglyceride concentration in lipid profile. A clustering of risk factors including high triglycerides, low good cholesterol, insulin resistance and obesity – especially if begun in childhood – puts one at higher risk for future cardiovascular disease,” warned Maria Van Rompay, research associate at the Friedman School of Nutrition Science and Policy at Tufts University.
“The increase in good cholesterol was greatest among children who decreased their intake by one or more servings of SSBs per week compared to those whose intake stayed the same or increased.”
Eating a walnut-rich diet can be effective in losing weight and improving cholesterol level, finds a study done by University of California. The research also showed that a diet containing walnuts, which primarily comprise polyunsaturated fats, positively impacts heart health markers.
Eating fresh avocados every day can significantly change lipid profiles and improve cholesterol levels, revealed a study conducted at the University of the Pacific at Stockton in California. According to the findings, the use of avocados in lieu of solid fats and foods that have higher saturated fat content, significantly change lipid profiles.
“Fresh avocado, as part of a balanced diet and as a cholesterol-free substitute for solid fats can help be part of the solution for maintaining normal cholesterol levels,” said Nikki Ford, PhD, director of nutrition from Hass Avocado Board in the US.
Barley is high in fibre, has twice the protein and almost half the calories of oats as well as an important consideration for people with weight or dietary concerns. According to a new study conducted by St Michael’s Hospital in Canada consuming barley as food or in food recipes can significantly reduce the levels of “bad cholesterol” that are associated with heart disease risk, suggesting that barley has similar cholesterol-lowering effects as oats. Barley has a lowering effect on the total bad cholesterol in high-risk individuals, but can also benefit people without high cholesterol. High cholesterol and diabetes are the major risk factors for heart disease and stroke.
7. Red Wine
Drinking red wine can ward-off cholesterol build-up resulting from eating red meat, say scientists. Harmful compounds from red meat form in the bloodstream, creating “bad” cholesterol that damages blood vessels and heightens cardiac risks. However, antioxidants in wine, known as polyphenols, prevent these compounds from being absorbed into the bloodstream where they can cause harm. Therefore, including polyphenol rich products as an integral part of the meal may significantly diminish these harmful effects.
8. Unsaturated Fats
Consuming omega-3 essential fatty acids, found in unsaturated fats, help to lower the levels of bad cholesterol in the blood. Unsaturated fats include oily fish, nuts and seeds, ground flax seeds, olive oil and certain vegetables and fruits.
Nuts (mainly pistachios, almonds and walnuts) have been shown to have beneficial effects on glycemic and lipid parameters. Pistachios have a low glycemic index, are naturally cholesterol free, and are source of protein, fibre and antioxidants. These properties make consumption of pistachios potentially useful for those at risk for obesity and heart disease.
An adequate level of ‘good cholesterol’ is as essential as avoiding bad cholesterol to keep away from heart ailments and other diseases. Not having enough good cholesterol may prove bad for health. So it’s important to pay attention to managing your cholesterol levels.
5. Nutritional Intervention
One of the most intriguing areas of research within treating atherosclerosis and heart disease is nutritional intervention. Most doctors agree that diet is one of the most effective ways to prevent atherosclerosis. The American Heart Association have released specific diet guidelines to prevent cardiovascular disease. Their major guidelines are to consume a variety of fruits and vegetables and grain products, including whole grains, as well as including fat-free and low-fat dairy products, fish, legumes, poultry, and lean meats . They also say to maintain a desirable blood cholesterol and lipoprotein profile by limiting the intake of foods with a high content of saturated fatty acids and cholesterol and to substitute grains and unsaturated fatty acids from vegetables, fish, legumes, and nuts .
Doctors and other researchers have taken this idea further, to treat and even attempt to reverse cardiovascular disease through aggressive nutritional intervention. One of the strongest advocates for this method is Dr. Caldwell Esselstyn from the Wellness Institute of the Cleveland Clinic. Dr. Esselstyn claims, “Though current medical and surgical treatments manage coronary artery disease, they do little to prevent or stop it. Nutritional intervention, as shown in our study and others, has halted and even reversed coronary artery disease” . His study involved 198 volunteer patients with established cardiovascular disease. These patients transitioned from a usual diet to plant-based nutrition. They were only considered active participants if they completely refrained from dairy, fish, and meat. Whole grains, legumes, lentils, other vegetables, and fruit comprised the major portion of the diet.
Of the 198 participants, 177 were able to adhere to the plant-based diet. The researchers followed up with the participants over a 44-month period. In the group of 177 adherent patients, 112 reported angina at baseline and 104 (93%) experienced improvement of resolution of systems during the follow-up period. Major cardiac events judged to be recurrent disease totaled one stroke in the adherent cardiovascular participants, a recurrent event rate of .6% . Thirteen of the 21 nonadherent participants experienced at least 1 adverse effect each, 2 sudden cardiac deaths, 1 heart transplant, 2 ischemic strokes, 4 PCIs with stent placement, 3 coronary artery bypass graftings, and 1 endarterectomy for peripheral arterial disease. There are a number of potential confounding variables to consider in these results. If one of the participants was hospitalized, they would not be able to choose their meals and would be placed into the nonadherent group. We must also take into consider that there is no control group in this study. All participants were volunteers, who had an interest in adhering to a plant-based diet. It would be beneficial to compare the results with a control group with established coronary artery disease that did not attempt to change their diet. Another confounding variable is that even though all participants had established coronary artery disease, the extent and severity of the disease varied for each individual. It is possible that the participants with the most severe coronary artery disease did not see any improvement of their symptoms and discontinued the diet. Further research with larger study groups and a randomized control group would be helpful to explain why the results of this study are so favorable.
Another study, published by the Atherosclerosis Journal, shows the positive correlation between vegetables and circulating endothelial progenitor cells . In this study, forty-five healthy young women were employed and randomized to a dietary intervention group or a control group. Subjects in the intervention group received typical Okinawan vegetables through home-parcel delivery for 2 weeks. After the 2-week dietary intervention period, endothelial progenitor cells were significantly increased in the intervention group and were not in the control group. Changes in the endothelial progenitor cell number were inversely correlated with changes in both serum total cholesterol and low-density lipoprotein cholesterol level. The results suggest that green, leafy vegetables help to restore and rebuild healthy endothelium through increasing the number of endothelial progenitor cells. The results also establish a correlation between decreased numbers of endothelial progenitor cells and higher levels of serum cholesterol and LDL cholesterol levels, both risk factors of atherosclerosis and heart disease.
In another comparable study done in 1985, 22 patients with severe coronary artery disease were followed over a five-year period . These patients took cholesterol-lowering drugs and followed a diet that derived no more than 10% of its calories from fat. The progression of their disease was angiographically documented by Dr. Ornish. These results were quantified with the percent diameter stenosis and minimal lumen diameter methods. Of the 22 participants, 5 dropped out within 2 years, and 17 maintained the diet, 11 of whom completed a mean of 5.5 years of follow-up. All 11 of these participants reduced their cholesterol level from a mean baseline of 246 mg/dL to below 150mg/dL . Lesion analysis by percent stenosis showed that, of 25 lesions, 11 regressed and 14 remained stable. Mean arterial stenosis decreased from 53.4% to 46.2%. The mean decrease of arterial stenosis of 7.0% (P<.05) was greater than any reported in previous research. After the longitudinal study was complete, six patients continued this same diet and reported no further coronary events such as stroke or myocardial infarction. All five dropouts who resumed their prestudy diet reported new cardiac events. These included four instances of increased angina, two episodes of ventricular tachycardia, one coronary arterial bypass operation, one angioplasty, one case of congestive heart failure, and one death from complications of arrhythmia. In this study there was no specific control group noted. To more completely understand what specifically correlated with the lesion regression, it would be helpful to compare the lesion analysis to a control group that received the same cholesterol-lowering medication, with no change in diet. There are also a number of contributing factors that could have played a role in these results. The support system for this experimental group contributed to the patient’s ability to stay on the diet. The social, psychological, or physiological factors from this support system may be more important for treating heart disease than the diet itself. A large, randomized control group would help to further correlate the diet with the results.
Other studies have analyzed more modest low-fat diets used in combination with drugs and achieved only partial success . Dr. Esselstyn concludes, “ If the ultimate goal of treatment is total arrest of heart disease, it appears that the combination of less than 10% fat nutrition and cholesterol-lowering drugs is most likely to achieve the greatest reduction in serum lipids” .
Dr. Esselstyn suggests that it is the Western diet of added oils, dairy, meat, sugary foods, sugary drinks, refined carbohydrates, fruit juices, syrups, and molasses that set off the cascade leading to progressive endothelial injury, atherosclerotic plaque, and eventually cardiovascular disease. He adds that this “makes food choice a major, if not the major, cause of coronary artery disease. Future discoveries may help to explain why plant-based nutrition is so effective, yet we can postulate likely mechanisms. When foods that injure or cause endothelial dysfunction are avoided, the body readily restores the capacity of endothelial tissue to produce nitric oxide. Such change reduces production of vasoconstricting endothelin and thromboxane by injured endothelial cells” .
The question arises, is it reasonable to believe patients can maintain a diet of less than 10% fat nutrition throughout their lives? From the previous study we see that six patients continued to adhere to this strict diet, even though there were no longer being angiographically measured for the study. What were the factors for these six patients long term success?
Evidence from the Monel Chemical Senses Center, which studied three groups of volunteers who consumed different levels of dietary fat, suggests that people can lose their craving for fat. In the Monel study, only the patients whose diet contained less than 15% of calories from fat lost their desire for fat after 90 days . This helps to make sense that more patients were able to continue to adhere to the 10% fat diet, rather than the more modest low-fat diets that were used in previous research. These findings also tell us that, in the first 90 days, the patient is in need of intense social support. There is early difficulty recognizing acceptable no-fat foods and dealing with the constant challenge of redesigning most traditional choices at every meal. In Dr. Ornish’s experiment, a list of fat-free recipes taken from low-fat cookbooks and other resources on weight loss, cardiac health, and healthy lifestyle changes was given to each participant. For the initial several months, the constant challenge of shopping for appropriate foods and finding appropriate menus was a major focus .
There were also two other major factors that helped the participants adhere to the extreme change in their diet. Dr. Esselstyn credits Dr. Ornish by saying, “the physician had also adopted the diet and was thus a consistent role model for the participants. He actively involved himself in their care through frequent personal contact over a period of years and through periodic semisocial meetings that centered around the treatment plan. His personal investment in the success of his participants was clear to them. He was a credible source of information and was supportive of their efforts, especially through the more difficult initial stages of the study” . The patients were also motivated by their initial weight loss, improved feeling of well-being, and decreasing angina.
In another study done at Tufts University, researchers concluded that healthier eating habits and a bit of discipline can help recondition the human brain to prefer healthy foods to junk foods . The researchers found that people did not start out their lives with a love for French fries and other junk foods. People gain those cravings through eating it repeatedly. Susan B. Roberts, a professor of both nutritional science and psychology at the Tuft’s Friedman School of Nutrition Science and Policy and Tufts University School of Medicine, studied MRI images of the brains of obese and overweight participants before and after completion of a six-month weight loss program. The results showed the areas of the brain associated with learning and addiction were transformed, with pleasure response centers becoming more sensitive to healthier food and less drawn to unhealthy, higher-calorie foods . This supports the hypothesis that unhealthy habits are not necessarily fixed and that improved eating habits can be adopted and maintained. The findings suggest that we may begin to crave strict diets, such as the one used by Dr. Ornish to stop the progression of atherosclerotic plaque in his patients, if we condition our brain by repeatedly eating healthy foods.
Additional research supports the hypothesis that the Western diet of eating a high concentration of meat, oil, and dairy plays a large role in America’s high rate of cardiovascular death. In other cultures and society where plant-based nutrition is prevalent there are extremely low rates of cardiovascular disease. In a paper authored by Strom and Jensen, they observed that in Norway between 1938 and 1948 there was a strong relationship between cardiovascular mortality and changes in intake of fat in the form of butter, milk, cheese, and eggs, with the changes in mortality lagging behind dietary changes by approximately one year . From 1940 to 1945 Germany occupied Norway during World War II. During this time, German occupying forces confiscated their livestock, limiting Norwegians to plant-based nutrition. The death rate from strokes and heart attacks plummeted during this time. After World War II and the German occupation period, the Norwegians started eating animal based products again and the cardiovascular death rates increased as well.
The results from this study may correlate animal based products with cardiovascular disease, but there are a number of other explanations which could have contributed to these results. Another study observing the nutritional conditions during this time period in Norway points out other nutritional factors that have been shown to play a significant role in cardiovascular disease . During the German occupation period, Norwegians calorie intake was 20% less than during the preoccupation period. Sugar intake was also cut in half during this time. Perhaps most significantly, fish consumption increased by 200%. There are a number of studies correlating fish intake with improved omega-3/omega-6 ratio and cardiovascular health.
Another well researched story that further supports plant-based nutrition is called “The Berry Project” and was designed in Finland to help farmers convert from dairy farming to berry farming. In 1973 Finnish men had the highest ischemic heart disease mortality rate in the world. The main focus of the strategy was to reduce the high saturated fat intake. Finnish villages were invited to participate in a cholesterol-lowering competition to demonstrate the feasibility of changing their diet and obtaining measurable, positive outcomes. The results were promising, as ischemic heart disease mortality decreased by 65% in the whole country from 1973 to 1995 .
Another positive effect that plant-based diets have on our health is its impact on our gut microbiome. Researchers have been continuing to unfold our understanding of the microbiome and its effect on human biology. As humans we have more bacteria than we do cell and gene count. The microflora has been found to have health promoting effects such as improved digestion, absorption, vitamin synthesis, and lowering of gas distension . The good news is that we can alter our own microflora depending on the foods we eat. A study between two monozygotic Finnish twins found that diet played an important role in the modulation of their stool microbiota. The cotwins who ingested the same amounts of saturated fatty acids had very similar denaturing gradient gel electrophoresis profiles of Bacteroides spp., whereas the cotwins with similar consumption of fiber a very low bifidobacterial denaturing gradient gel electrophoresis profile similarity . There are certain bacteria within the gut microflora that further breakdown the carnitine and choline found in animal products to trimethylamine (TMA). TMA is then transported to the liver where it is converted by an enzyme into trimethylamine N-oxide (TMAO). There are multiple studies published in 2013 that indicate that high levels of TMAO in the blood are associated with an increased risk of major adverse cardiovascular events . A plant-based diet appears to select against gut flora that produce TMA by essentially starving the bacteria of carnitine and choline. One study had a group of vegans consent to participating in a study where they ate red meat and had their blood TMAO levels monitored. The study found that the formation of TMAO from the carnitine challenge was negligible in the vegans, compared to the control group, who had their TMAO levels drastically increase from eating the same amount of carnitine . This concept explains the well-established link between high levels of meat consumption and cardiovascular disease risk. A recent article in the New England Journal of Medicine shows that choline in eggs, poultry, dairy, and fish produces the same toxic TMAO as carnitine in red meat . This further explains plant-based protection from heart disease.
Lowering Triglycerides and Raising HDL Naturally
Q: My father has heart disease and takes statin drugs. He is very careful about what he eats, and he exercises and takes supplements. However, his triglycerides remain very high. Can you tell me what causes this problem and how to treat this condition using supplements?
A:Triglycerides are a major cause of heart disease, and one that is frequently ignored or neglected. Nearly two-thirds of all coronary heart disease cases in the US can be at least partly blamed on abnormal triglycerides.
The two general categories of elevated triglycerides are familial (or inherited) and insulin resistant. The familial variety, which is usually responsible for triglyceride levels of 400 mg/dL or greater, is relatively uncommon, and may or may not contribute to heart disease risk. The far more common variety of high triglycerides, usually in the range of 150-400 mg/dL, is often (though not always) associated with resistance to insulin, more commonly called “pre-diabetes.” This form is often a cause of heart disease.
The standard US guidelines for triglycerides and cholesterol, called the Adult Treatment Panel III, recommend that triglycerides be kept at a level of 150 mg/dL or lower. At what level, however, do triglycerides begin to add to heart disease risk? The answer is 60 mg/dL or higher. When triglycerides are present at a level of 60 or higher, several abnormal hidden particles begin to appear in the blood: very low-density lipoproteins (VLDL), intermediate-density lipoproteins (IDL), and, perhaps most important, “small” low-density lipoproteins (LDL). Small LDL alone can triple your risk for heart attack. Beneficial high-density lipoprotein (HDL) levels decrease as triglyceride levels increase. In other words, increasing triglycerides trigger a whole cascade of ill effects that cause coronary plaques to grow and that lead to heart attacks.
Measuring triglycerides is, therefore, among the most important blood tests you can take. There are several ways to lower triglycerides naturally:
Fish oil is an effective, safe way to lower triglycerides by up to 50%. It also very effectively lowers levels of the hidden particles that triglycerides create, such as VLDL and small LDL. In our coronary plaque regression program, I advise everyone to take a starting dose of 4000 mg per day of a concentrated fish oil extract. Niacin (vitamin B3) is another powerful way to lower triglycerides. Doses of 250-500 mg can be taken safely with food and plenty of water to help minimize the hot “flush” that, though harmless, can affect some users of niacin. Doses of more than 500 mg should be taken only under medical supervision.
High-fiber foods, especially products containing healthy beta-glucan such as oat bran and raw nuts like almonds and walnuts, slow sugar absorption. In effect, they lower the “glycemic index” of foods and thus can indirectly lower triglycerides.
Q: I am 43 years old and in good physical condition. While my overall cholesterol is under 200 mg/dL, my HDL tends to be very low. Any suggestions on how I can raise my HDL naturally?
A:This is a very important issue. As noted in the previous question, low HDL usually goes hand in hand with elevated triglycerides, though either can occur independently. Like elevated triglycerides, low HDL can be a powerful cause of heart disease. In fact, low HDL is by far the most common cause of heart attack in the US, even more so than high cholesterol. So why do we not hear more about raising HDL? One reason is that unlike lowering cholesterol, raising HDL does not generate huge profits for the pharmaceutical industry. Do not let this mislead you into thinking that HDL is not important.
At what level does HDL contribute to heart disease risk? The answer is any level below 60. Among the limited number of natural tools available to raise HDL are:
Niacin in daily doses of 250-500 mg commonly increases HDL by 15-20%. Higher doses should be taken only under medical supervision.
Weight loss has a powerful effect on raising HDL. For this reason, I often focus my patients’ strategies on accelerating weight loss through a carbohydrate-restricted diet (such as the South Beach Diet), regular exercise, and supplements such as calcium pyruvate. At a dose of 2500 mg twice a day, calcium pyruvate can help get your weight down quickly and safely.
Fish oil in a dose of 4000 mg per day has a modest benefit, usually raising HDL by 2-3 points.
Policosanol is a sugar-cane derivative that lowers LDL and raises HDL, though the effect tends to be very modest.
Chromium in a daily dose of 400-800 mcg “sensitizes” your body to its own insulin and can raise HDL a few points.
Additional lifestyle strategies to consider are avoiding both hydrogenated fats (which depress HDL and raise LDL) and refined starches such as flour-containing baked goods.
A cardiologist’s top 10 things to know about fish oil supplements
- Despite many studies done over the last few years, there is no absolute proof that taking omega-3 fatty acids will decrease your risk of having a heart attack. Studies are in progress to determine whether adding omega-3 fatty acids to a medical regimen including statins will lower your risk of a heart attack if you already have coronary artery disease.
- DHA (docosahexaenoic acid ethyl ester) and EPA (ethyl eicosapentaenoic acid) are the active ingredients in omega-3 fatty acids and have been shown in multiple studies to lower triglyceride levels. Triglycerides are a kind of fat, very different from cholesterol, that can cause irritation of the lining of blood vessels, especially when accompanied by low HDL (good) cholesterol.
- Although there are popular myths that taking fish oil lowers your cholesterol, it does not. It will lower your triglycerides, may modestly raise your HDL (which is a benefit), but can actually raise your LDL (bad) cholesterol, which is not a benefit. Only the pure EPA type of fish oil has been shown to not raise LDL cholesterol.
- Omega-3 supplements may have health benefits other than for the heart. Some people experience relief from arthritis pain and depression, and it may have a role in decreasing inflammation.
- One study that got a lot of attention in 2013 suggested that taking fish oil might increase a man’s risk of having prostate cancer. This caused much consternation, and led to many men stopping their supplements. The trial had many flaws in its design, and there is no good evidence that omega-3 fatty acids cause prostate cancer.
- There are many different products on the market, and not all fish oil is the same. Many are available over the counter, and they are not held to unified standards. Some may be very unpleasant to take. I will always remember when my brother bought an inexpensive salmon oil after I suggested he take a fish oil supplement. He immediately began burping up a fishy taste and of course blamed me! Look for a product rich in DHA and EPA, but even this is not a guarantee of quality.
- There are 3 prescription brands of omega-3 fatty acids, and they are all high quality. One, called Lovaza, is a mixture of DHA and EPA. The second product is called Vascepa, which contains only EPA. The third, Epanova, is purified in a different way, said to be more easily absorbed by the body. All the prescription brands are pricey, and all work in similar ways.
- Several generic versions of Lovaza have been available since 2014, yet many insurance companies will not cover any prescription-brand fish oil, or will charge a large co-pay, often making them prohibitively expensive.
- The usual dose for heart-disease prevention is 1 gram once or twice per day. If your triglyceride level is more than 200 mg/dl, you might benefit from higher doses, as much as 6 grams per day. Keep in mind that fish oil has 9 calories per gram.
- Side effects from omega-3 fatty acids, other than burping up a fishy taste, may include stomach distress, diarrhea, and heartburn. Keeping it refrigerated can help with heartburn. There may be a slight risk of increased bleeding, which is why someone who needs elective surgery is asked to not take fish oil for at least a week before the operation. In rare cases, allergic reactions are possible. Remember to store your supplement in a cool, dry place, as fish oil can become rancid in the heat, making it ineffective as well as unpleasant.