logoThe People's Perspective on Medicine

Flip Flops on Fish Oil: Omega 3 Fats Now Have Heart Benefits

Studies of supplements rich in omega 3 fats have reached conflicting conclusions. The latest analysis concludes that they reduce the risk of heart disease.
Healthy fish oil nutritional supplements pills / close-up macro

Are you fed up with flip flops? The latest U-turn on dietary supplements has to do with omega 3 fats. There was a time when Americans were told that little golden footballs containing some kind of fish oil would be good for them. Then they were told it would not protect the heart and might raise blood sugar levels or increase the risk for a bleeding stroke. But now, fish oil is back!

The Waxing and Waning of Omega 3 Fats:

Scientific support for fish oil supplements (omega-3 fatty acids abbreviated n-3) has waxed and waned over the last 50 years. Now, the same researcher who said fish oil was worthless for the heart has changed her tune.

Dr. JoAnn Manson is a Professor of Medicine at Harvard Medical school and Chief of the Division of Preventive Medicine at the Brigham and Women’s Hospital in Boston. She is considered one of the nation’s leading epidemiologists. She holds an endowed chair (the Michael and Lee Bell Professor of Women’s Health) at Harvard.

Writing in the New England Journal of Medicine (Jan. 3, 2019) she and her colleagues concluded that:

“Supplementation with n-3 fatty acids did not result in a lower incidence of major cardiovascular events or cancer than placebo.”

Nine months later Dr. Manson and her co-authors concluded:

“Marine omega‐3 supplementation lowers risk for myocardial infarction [heart attack], CHD [coronary heart disease] death, total CHD, CVD [cardiovascular disease] death, and total CVD… Risk reductions appeared to be linearly related to marine omega‐3 dose” (Journal of the American Heart Association, Sept. 30, 2019

In other words, the higher the dose of fish oil, the lower the risk of heart problems. So, the same distinguished physician and researcher did a U-turn on omega-3 fatty acids in less than a year. 

Readers and Omega 3 Fats:

Many readers of this column have stuck by fish oil despite the ups and downs of the research.

One shared this story:

“I have been taking 4 grams of premium fish oil capsules for 20 years. This began on the recommendation of a lipid specialist at a major teaching hospital in Houston.

“He prescribed prescription Lovaza (fish oil) for my high triglycerides and low HDL. I had suffered a heart attack 5 years earlier that was treated with balloon angioplasty.

“Since then my triglycerides have been under 100, and my HDL and LDL are in perfect range. I had a stent placed in the same area as the angioplasty about 12 years after the heart attack. I no longer take any prescription meds for my heart and the fish oil is OTC. No doctor has ever questioned why I am taking it or told me it was useless.”

A Cardiologist Says Omega 3 Fats Are Worthless:

Another reader had a different experience:

“I started taking omega-3 fatty acids about 10 years ago. I developed a heart problem and continued taking fish oil because the data that I read was encouraging.

“My cardiologist told me it was useless, so I stopped. Doctors are not always correct. Last week, after I read the results of newest study, I bought my new supply. My instincts were correct after all.”

Omega 3 Fats vs. Arthritis:

Some people take fish oil for a completely different reason:

“I discovered, somewhat by accident, that fish oil is great for my osteoarthritis. I had been taking Aleve for years along with fish oil for my heart (I am currently 69).

“Around five years ago, I ran out of fish oil and didn’t get around to getting more for a week–all my arthritis pain came back! So I discovered that Aleve was not the pain killer that worked on my joints.

“Once I got back on the fish oil, it took a couple of weeks to kick back in, after which, I never took Aleve again. I take 1000 mg of omega-3 fatty acids twice a day (a total of 2000 mgs of omega 3 fats every day) and do fine without any other pain killers.”

Join over 150,000 subscribers at The People's Pharmacy

Does Research Support Fish Oil for Arthritis?

Many health professionals pooh-pooh dietary supplements like omega 3 fats. They assume that there is little, if any, scientific evidence to support fish oil for arthritis. Here is “A Critical Review” on the use of “Omega-3 Fatty Acids in Rheumatic Diseases” (Journal of Clinical Rheumatology, Sept. 2017). 

The authors note:

“Many clinical trials of omega-3 fatty acids, supplied as fish oil supplements, have been carried out in rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), lupus nephritis, and osteoarthritis (OA) over the past 3 decades…”


There are 20 clinical trials for rheumatoid arthritis (RA). Of those, 16:

“exhibited significant improvements in multiple disease clinical outcomes.”


There are 9 clinical trials involving systemic lupus erythematosus (SLE). Of those, 6

“6 exhibited significant improvements in 1 or more clinical outcomes.”


“A total of 4 clinical trials have been conducted in OA [osteoarthritis], of which 3 exhibited significant improvements in at least 1 clinical parameter. Multiple mechanisms for the clinical effects of omega-3 fatty acids have been implicated, including the modulation of eicosanoid synthesis toward a more anti-inflammatory profile and suppressed production of proinflammatory cytokines. Overall, fish oil supplements appear to be a safe and effective agent that could be added to the current treatment regimens in RA.”

A more recent study published in Joint, Bone, Spine (July, 2019) reports:

“In animal studies omega-3 polyunsaturated fatty acids reduced the expression of inflammatory markers, cartilage degradation and oxidative stress in chondrocytes… Human intervention studies with omega-3 polyunsaturated fatty acid supplementation may indicate a beneficial effect on pain and function and might be associated with less structural damage… Existing studies indicate a promising effect of especially omega-3 polyunsaturated fatty acids on osteoarthritis signs and symptoms.”

Omega 3 Fats and Osteoarthritis–A Reader’s Perspective:

Theresa shares this story about fish oil and OA:

“I have been taking some type of fish oil since the 90s. I burned my knees out from step aerobics and jogging. That led to the ole crunchy knees syndrome. I went to a sports doctor and he told me to take fish oil. At that time, it was a new treatment.

“I am now 61 and have no knee pain at all (knock on wood). All my friends and family have painful knees, but I seemed to have escaped that fate so far. I am hoping it has been beneficial for my heart too.”

What to Make of Fish Oil Flip-Flops?

The newest analysis of fish oil for the heart reminds us that science is constantly evolving. At least today we can say that omega 3 fats are good for the heart. You can learn more about the history of fish oil at this link plus more information on the pros and cons of omega-3 fatty acids.

What Do You Think?

Share your thoughts and experiences with fish oil in the comment section below.

Appreciate The People’s Pharmacy?

Do you find this kind of information helpful? If so, please share this article with a friend. Google has made our website virtually disappear. Whereas our health information used to come up high on Google searches, our content is now very hard to find. As a result, traffic to www.PeoplesPharmacy.com has declined over 50%.

If you appreciate what we do you may wish to support our work by going ad-free. Here is a link to learn how

Rate this article
4.1- 7 ratings
About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
Tired of the ads on our website?

Now you can browse our website completely ad-free for just $5 / month. Stay up to date on breaking health news and support our work without the distraction of advertisements.

Browse our website ad-free
  • Manson JE et al, "Marine n-3 fatty acids and prevention of cardiovascular disease and cancer." New England Journal of Medicine, Jan. 3, 2019. DOI: 10.1056/NEJMoa1811403
  • Hu Y et al, "Marine omega-3 supplementation and cardiovascular disease: An updated meta-analysis of 13 randomized controlled trials involving 127 477 participants." Journal of the American Heart Association, Sept. 30, 2019. DOI: 10.1161/JAHA.119.013543
  • Akbar U et al, "Omega-3 fatty acids in rheumatic diseases: A critical review." Journal of Clinical Rheumatology, Sept. 2017. DOI: 10.1097/RHU.0000000000000563
  • Loef M et al, "Fatty acids and osteoarthritis: Different types, different effects." Joint, Bone, Spine, July, 2019. DOI: 10.1016/j.jbspin.2018.07.005
Join over 150,000 Subscribers at The People's Pharmacy

We're empowering you to make wise decisions about your own health, by providing you with essential health information about both medical and alternative treatment options.

comments (16 total)
Add your comment

The latest research has improved fish oil data and sharpened our definition of what EPA/DHA can do. Yet, notably absent from the latest data is any protection from hemorrhagic stroke, although no specific contraindication statement is made. Is this new “flip flop” merely continued damnation by faint praise for fish oil and bleeding stroke?

I take 4K units a day, 2k in the morning and 2k in the evening, along with B3(nicotoninc acid)1000 units, D3 (5000 units), 20mg statin, and 81mg aspirin. My calcium score did not stabalize until after I added a CPAP nightly. For my particular circumstances, I’m finding that aleep apnea is a major driver for CVD. Now my calcium score is stable, and I hope to see it reverse.

I only take fish oil once a week because it is a blood thinner and causes me to get mystery bruises. So I can see how it might increase the risk for a bleeding stroke for some people. One supplement does not fit all.

Fish oil works for my arthritis, also. Years ago I had arthritis in my neck. Not wanting another prescription drug, my doctor suggested I try fish oil and told me I would have to wait for it to kick in. It did. Now, at 87, if I don’t take my 4 to 5000mg a day, I’m going to be aching all over within a day or two. You do have to get the genuine fish oil, however, so stick with the known brands.

1.Read your book years ago, like your information, and look forward to the emails. I share some of the discussions with others as well.
2.Regarding fish oil: Important to get a “clean” product, ideally, molecularly distilled. Another test of purity is the freezer test: open 3-4 soft gels, and freeze 6 hrs or more: if it solidifies, it has impurities. This would not be a valid test for some liquid forms due to added flavors, etc.

Dr Maroon, a spinal surgeon, found fish oil extremely helpful over several months in his patients for spinal pain due to the anti inflammatory process (reduces some of your body’s swelling reaction to compression in the spine). See also Drs Hibbeln and Sears for other beneficial fish oil studies.
Look at the DHA and EPA for the appropriate potency. Most adults need at least 2,000 mg of EPA +DHA daily (with fatty food like avocado or nuts increases absorption about 3x).
I do not suggest taking the short omega-3 found in flax oil, since it is hard for our bodies to change this into the long forms (EPA, DHA). (NOTE: I do like dietary ground flaxseed, but not for the omega-3 source.) Rather than taking omega 3-6-9, consider taking fish oil for the omega-3, use unfiltered virgin olive oil in your diet for the omega-9, and look for either borage oil or evening primrose oil for the beneficial omega-6 (gamma linolenic acid). Avoid other omega-6 oils if possible (sunflower oil, safflower oil, soybean oil) since we tend to get way too much in our SAD diets compared to the omega-3.

I’ve used fish oil successfully for years for lupus, osteoarthritis, dry eye, and cardiovascular benefits. It was recommended to me by 3 different specialists, & if they changed their minds about it tomorrow, their updated opinion wouldn’t change my mind about the benefits of fish oil.

I’ve found that quality matters in fish oil, as it does in many things in life. The amount & ratio of EPA & DHA also matter. Whether or not a solvent is used in processing can make a difference. Some brands of fish oil have made my joint paint worse, but a solvent-free brand eliminated that problem. Not everyone may have that sensitivity.

I’ve seen some studies that show rancidity in many OTC fish oils. IMO rancid PUFAs can do more harm than good.

What in the world would make Google do that to you? We need your carefully considered info. Is Big Pharma at fault?

But again, two of your advertisers: Is the grape seed/skin product complementary to CocoVia? Or would you suggest only one of these every day?

Hi John,

We only permit advertisers that are carefully vetted. We do not, however, make recommendations about what any individual should take. Sorry.

Thanks for the words of support. Google seems to favor organizations that are considered FDA-approved and “mainstream.” There is also a blessing of organizations that have connections to Pharma. We make no accusations, but it is clear that independent watch dogs, such as The People’s Pharmacy, have been in essence black listed.

This is a great article and I would have given it 5 stars except you did not give any information about dosing other than the testimonials from people. With all that research, is there not a recommended level? I am seriously interested in fish oil supplementation, but I would like to take an adequate dose without going overboard.

I started taking a high-quality fish oil for my triglycerides about 3 years ago. They didn’t do much for those lipids, which I brought down through diet and weight loss. But the fish oil did have a wonderful unintended side effect: it was magic for my generalized anxiety disorder. Two days after starting a 4-gelcap/day regimen, my GAD symptoms vanished and have not returned.

However, the brand and quality matter. Nordic Naturals 1200mg fish oil gelcaps gave me instant anxiety relief, but when I ran out one day and did the old, “Oh, I have this other brand, I’ll just take these until I can get to the store” routine, my anxiety symptoms roared back. I’m back on Nordic Naturals daily now, never to stray again.

Love all of the information I read from your email.

* Be nice, and don't over share. View comment policy^