By all current scientific understanding, omega-3 rich fish oil supports a healthy heart and blood vessels. But there has been some circulating suspicion based on scholarly reviews like this one that DHA, an omega-3 fatty acid found in fish oil, increases LDL cholesterol and therefore may actually increase cardiovascular disease risk.

Using fish oil as a therapeutic intervention for aberrant cholesterol levels and inflammation is common because it has saved lives. Here is what we learn from established research:

  • Fish oil reduces inflammation, a major process that several chronic diseases have in common. Chronic inflammation is linked to heart disease, diabetes, obesity, cancer, depression, osteoporosis, and other life-altering problems. Both EPA and DHA can lower inflammation through different mechanisms, including making anti-inflammatory chemical messengers and repairing cell membranes. The key is a healthy omega-3 to omega-6 ratio.
  • Fish oil lowers triglyceride levels, more successfully when both major omega-3 fatty acids found in fish oil, EPA and DHA, are present, though EPA is the major contributor. High triglycerides over long periods of time mean fatty buildup in your liver, which can lead to more problems than just cardiovascular disease. Usually, lowering triglycerides is a therapeutic goal – not a problem.
  • Fish oil raises HDL-c, the “good” cholesterol that tends to reduces risk of heart disease. It appears that DHA is the major contributor. Usually, raising HDL is a therapeutic goal, not a problem, as many people have low levels.
  • Fish oil, a mixture of EPA with DHA, raises LDL-c, the “bad” cholesterol.  EPA taken alone does not raise LDL while DHA taken alone does. While fish oil improves the quality of LDL particles and therefore has therapeutic value, this increase in LDL-cholesterol is considered to be a problem for some.

Fret not- this fishy fear has a flimsy foundation and by the time we have taken a deeper dive into why, you will likely learn a few important facts about fat and heart disease risk that will serve you well! Allow us to set the record straight on why you should feel comfortable both eating sustainably caught fatty fish and taking a high quality fish oil supplement.

LDL, LDL-c, HDL, HDL-c, and your Fat Shuttle System

First of all, those numbers on your cholesterol profile ending in “L” (for lipoprotein) are far more than just cholesterol! They are the cholesterol contained inside a specific lipoprotein carrier.

  • A lipoprotein is a fat and cholesterol taxicab with a license plate made of protein.
  • LDL stands for low density lipoprotein. Low density means “high in fat.” LDL-c is often referred to as the “bad” cholesterol because LDL particles bring fat, cholesterol, and fat-soluble vitamins from your liver to the rest of your body. When that waxy plaque accumulates in your arteries, the taxicab that got the cholesterol there is often blamed for the plaque buildup.
  • HDL stands for high density lipoprotein. High density means “low in fat.” HDL does the opposite of LDL, taking fat, cholesterol, and fat-soluble toxins from your tissues and bringing them back to your liver, so HDL-c is often called the “good” cholesterol.

So is HDL-c good and LDL-c bad? The reality is somewhere in between. Very high and very low LDL-c are bad. Very high and very low HDL-c are also bad. There is a sweet spot of balance, where fats move to and from your liver, meeting your body’s needs without clogging your arteries. DHA in fish oil (and from algae!) appears to raise both HDL-c and LDL-c at the same time.

Think about what this means for LDL:  If the LDL taxicabs are made well, bringing the right quality and quantity of fat, cholesterol, and vitamins to your cells that they need, AND there aren’t so many taxicabs that they cause a traffic jam, then LDL isn’t that “bad” after all. When you eat high-quality saturated and omega-3 polyunsaturated fats like organic grass-fed dairy or wild caught fatty fish, LDL-c and HDL-c both increase. If you are dealing with inflammation and/or consume poor quality saturated fats/trans fats, LDL-c is likely to increase while HDL-c is likely to decrease. Beyond diet alone, chronic inflammation will increase LDL-c and triglycerides while decreasing HDL-c. This is why an anti-inflammatory diet with high quality fats like fish oil can help you balance your cholesterol panel: boost HDL, lower triglycerides, and lower total cholesterol. But there is a bit more to the story with LDL-cholesterol.

Big and Fluffy beats Small and Stuffy

We now understand that not all LDL particles are the same- it’s just that your standard cholesterol panel does not give you all of the information you may want.

  • First of all, LDL particles that are light and fluffy and filled with healthy fat, cholesterol, and vitamins support your cells’ nutritional health. Take more fish oil and these are likely the LDL particles that your liver will make more of. Small, oxidized LDL particles are more likely to end up clogging arteries and are correlated with a higher risk of all causes of death, not just cardiovascular events!  Studies like this one on type 2 diabetics already on statin therapy demonstrate that fish oil can improve the quality of LDL particles while reducing triglycerides.
  • Secondly, less is more, in terms of the number of LDL particles. While the total amount of cholesterol in the particles may increase (LDL-c), fish oil tends to drive down the actual number of low-density lipoprotein particles. Think of the difference: A fire rages in a building on a crowded city street. Would the scene get more congested with a few large fire trucks or a fleet of fire vans? Less particles that carry more nutrition are less likely to cause congestion.

So, when do we find smaller, oxidized LDL particles? During infection or inflammation, your liver makes more fatty acids, triglycerides increase, LDL-c increases, and the number of small dense LDL particles increases. HDL-c decreases but the number of small dense HDL particles increases. Small, oxidized HDL particles have reduced functionality and cannot bring cholesterol back to the liver as effectively.

Recent research funded by the National Institutes of Health provides a stunning revelation: omega-3 levels are actually more predictive of cardiovascular risk than cholesterol levels are!  Inflammation is the connection. Fish oil has the opposite effect of inflammation or infection on your cholesterol panel, having been shown to reduce triglycerides, boost HDL cholesterol, and decrease the number of small, oxidized LDL particles. Your LDL-cholesterol is a measure of the cholesterol in your LDL particles. Fish oil can boost that number on your cholesterol panel and make big, fluffy LDL particles, but it also lowers the total number of LDL particles. Both changes reduce your risk of cardiovascular disease. The key is to make sure you are consuming fats of high quality and living an anti-inflammatory lifestyle to get LDL and HDL in balance.

Focus on Fish Oil: EPA and DHA

Let’s laser in on how you can use this information- how to get those fishy fats of high quality for balanced cholesterol and a healthy heart!

Both DHA and EPA modulate metabolic pathways positively, lowering triglycerides, improving the integrity of arteries, boosting blood flow to fill the heart, reducing platelet action and risk of clotting, and quelling inflammation and oxidative stress. EPA is particularly helpful for reducing inflammation (putting the fire out in a burning building) and HDL-boosting DHA is particularly helpful for improving repair (restoring the building).

Now you can more clearly see why inflammation-reducing EPA in fish oil has this balancing effect on a cholesterol panel! But…what about brain-boosting DHA? Consider that DHA has been shown to both raise HDL-c and LDL-c at the same time, meaning that while you are bringing more fats to your cells, you boost re-cycling of cholesterol and other fats from the cells. If you focus on quality as much as quantity, these changes are not pathological- they support healthy cell membranes and keep fat-based nutrition moving to the tissues that need it.

FOOD – Quality is essential for your seafood sourcing.

  • Feed on fatty fish. Salmon, mackerel, sardines, and anchovies are great choices due to their size and relative sustainability. For vegans, algae-based DHA is available- but as you may note from above, isn’t likely to be as metabolically effective as an animal-sourced EPA/DHA fish oil. Need a great source for high quality fish? Consider supplementation if you do not tolerate seafood (see below).
  • Reduce your intake heavy metals like mercury and fat-soluble toxins. Toxins get concentrated up the food chain, so choose smaller fish (like sardines, anchovies, salmon, or Spanish mackerel) to protect yourself. If you are pregnant or planning on becoming pregnant, consume 2 servings of fatty fish per week to reap the reward with less risk.
  • Don’t get sucked in to unsupported health claims about plant-based omega-3 sources. Plant-based omega-3 fats, mostly ALA (alpha linolenic acid), are barely converted to EPA (max 10% in men and 21% in women) and subsequent DHA (max 4% and 9% respectively), and have not been shown to be of therapeutic value for reducing inflammation in research. DHA from algae works great- as only DHA. Halfway to goal is still very far from goal.

LIFESTYLE – What is your life like and what is your current omega-3 (vs. omega-6) status?

  • Know yourself and you will make the best possible choices about eating and supplementing omega-3 fatty acids. Do this best with Spectracell’s test, which can give you your omega 3 to omega 6 ratio. This ratio is critical for understanding your risk of chronic inflammation and to assess your heart disease risk.
  • Do you live in a big city, are post-menopausal, or looking to become pregnant? Some of us that need more omega-3 fats and aren’t at a high risk of heart disease aren’t necessarily aware of the value of these anti-inflammatory fats. Read more here.

SUPPLEMENTATION – Though there are plenty of fish (oils) in the sea, none of them met our requirements. So we made our own.

  • We want you to get the nutrition you deserve that packs the biggest metabolic punch possible!  Origin Omega packs in over 700 mg of EPA and 700 mg of DHA every day. This is enough to show a therapeutic benefit in many studies, especially improvements in mental health.  Choose quality and get what you pay for.
  • Because EPA and DHA have been shown to compete for absorption we offer EPA and DHA separately, to be taken morning and night. This strategy is effective because:
    • EPA and DHA do not compete for absorption when taken separately, so you will absorb the most you can of both oils. Before we launched our Origin Omega supplemental fish oil with EPA split apart from DHA, we struggled with dosing our fish oil, recommending more EPA than DHA to get around this competition. However this left us absorbing some EPA and missing out on most if not all the DHA.
    • Enjoy your inflammation-busting EPA in the morning to support a less congested day.
    • Enjoy your brain-building DHA in the evening to set yourself up for true rest and repair while you sleep.
    • Other supplements have more EPA than DHA to get around this absorption problem and assume it works out all right. We don’t feel comfortable just assuming. With Origin Omega, you know what you are getting.
  • Origin Omega-3 fatty acids are in a triglyceride form closer to their fishy food origin, which potentially has more therapeutic value. Current research leans toward the triglyceride form, which we use in our fish oil because it is more like real food, more stable, and up to 340% better absorbed than the ethyl ester form. This food-form fish oil needs bile, lipases, and normal fat digestion for full absorption.
  • If you do not have a gallbladder or otherwise poorly absorb fats, you may benefit from adding lipase (a fat-digesting enzyme) into your mealtime supplements, and not just to help get the benefits of fish oil! There are plenty of fats (like our SKINNYFat Olive containing 85% less omega-6 fatty acids than other olive oils and is perfect for individuals with no gallbladder or that poorly absorb fats) and fat-soluble vitamins you may wish to get more of, especially to replace processed polyunsaturated vegetable oils and other trendy-but-still-poor-quality fats!

So while there is nothing to fear from fatty fish, you have a lot to lose if you don’t include them and their delicious heart-healthy fats on your plate! Enjoy fat-focused healthy summer meals like gently grilled salmon and a green salad drizzled with a heart-healthy vinaigrette, or faithfully take a properly formulated fish oil, like Origin Omega, to reduce inflammation and nurture your metabolism.

To your heart health!