The benefits of omega-3 fatty acids throughout the lifespan are well-established. Research supports their role in heart health, brain and eye development, cognitive health and more. More specifically, in relation to heart health, these fatty acids have been shown to help reduce the risk of heart disease and stroke. This is through improving blood vessel function as well as reducing inflammation, platelet aggregation, blood pressure and triglycerides.1,2
Are Supplements Effective?
While scientific evidence supporting the heart benefits of omega-3 fatty acids through dietary sources is strong, the effects of supplementation are unclear. Some studies have shown positive impacts, such as risk of death from cardiovascular disease.3 More recently, however, some meta-analyses have failed to show benefits. These include:
- A 2018 review, published in the Cochrane Library, examined the effects of omega-3 supplementation on heart and circulation, compared to those with normal or lower intakes of omega-3s. The authors reviewed 79 randomized trials, totaling more than 112,000 participants, of whom were both healthy and had existing illnesses. Results showed that long-chain omega-3 supplementation had “little or no effect” on the risk of cardiovascular events, coronary heart disease events, stroke, death from any cause, death from cardiovascular problems or death from coronary heart disease.
- A JAMA Cardiology meta-analysis reviewed 10 studies examining the association between omega-3 supplementation and risk of fatal and nonfatal coronary heart disease, nonfatal myocardial infarction, stroke, all-cause mortality and major vascular events. These trials involved at least 500 subjects (nearly 78,000 total) and the treatment period lasted at least one year (average length was 4.4 years). Researchers found that omega-3 fatty acid supplementation had no significant association with the main outcomes, and the findings do not support the use of supplements.
More research needs to be done on this topic, but as it currently stands, there is not enough evidence to support the use of supplements, rather than food, for the prevention and treatment of heart disease in healthy adults.
Recommendations for Working with Clients
When working with clients, first assess their current omega-3 fatty acids intake. If they could benefit from increasing their intake, begin with dietary strategies.
The three main omega-3 fatty acids are eicosatetraenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). Fatty fish, such as salmon, mackerel and trout, contain EPA and DHA. ALA is found in plant foods, including canola and soybean oils, flax, chia and hemp seeds and walnuts.
Both the Dietary Guidelines for Americans (DGA) and American Heart Association recommend consuming fatty fish twice a week. However, according to the 2015–2020 DGA, more than 80 percent of Americans consume do not meet this recommendation. To boost fish intake, help clients develop strategies to incorporate more fish into their diets. For example, if a client does not like the taste of fish, encourage them to incorporate seafood into familiar favorites, such as pastas or stir-fries, as this may help their taste buds adapt to the flavor. For those who do not feel confident in their cooking skills, offer education and resources to help them properly prepare fish.
Plant sources should also be encouraged and are especially important for vegetarians, vegans or clients with fish allergies. Provide recommendations to help these individuals incorporate sources of ALA into their diet. This might include using canola or soybean oil when cooking, adding chia seeds or flaxseeds to hot cereal or yogurt or snacking on walnuts. Keep in mind, this population may benefit from supplementation to avoid deficiency, as adequate quantities of ALA may be difficult to consume through food alone. Additionally, while the body can convert ALA to EPA and DHA, this is only in small amounts. If these clients choose to take a supplement, be sure their intake is below 3 grams per day, which is generally considered safe.
If you feel certain clients may benefit from supplementation for the treatment of disease, always consult with their physician before making recommendations.
- Rimm EB, Appel LJ, Chiuve SE, et al. Seafood Long-Chain n-3 Polyunsaturated Fatty Acids and Cardiovascular Disease: A Science Advisory From the American Heart Association. Circulation. 2018;138:e35–e47.
- Hammad S, Pu S, Jones PJ. Current Evidence Supporting the Link Between Dietary Fatty Acids and Cardiovascular Disease. Lipids. 2016;51(5):507–17.
- The Lowdown on Essential Omega-3 Fatty Acids in the Diet. Available at: https://foodandnutrition.org/january-february-2016/lowdown-essential-omega-3-fatty-acids-diet/.