Omega-3 and Heart Disease Risk

Written by Dr. Steve Chaney on . Posted in Omega-3s and Heart Disease

Why Is There So Much Confusion About Omega-3 and Heart Disease Risk?

Author: Dr. Stephen Chaney


omega-3 heart diseaseConcerning omega-3 and heart disease, the pendulum keeps swinging. In the 1990’s several strong clinical studies showed that omega-3s reduced heart disease risk. In fact, a major clinical study in Italy, (Lancet 354: 447 – 455, 1999 , Circulation 105 : 1897 – 1903, 2002 ), found omega-3s to be just as effective as statin drugs for preventing heart attacks, but without any of the side effects of statins.

At that time, everyone was talking about the benefits of omega-3s in reducing heart disease risk. The American Heart Association recommended an intake of 500-1,000 mg/day of omega-3s for heart health. Some experts were recommending even more if you were at high risk of heart disease.

In the 2000’s the pendulum swung in the other direction. Several clinical studies found no benefit of omega-3s in reducing heart disease risk. Suddenly, experts were telling us that omega-3s were overrated. They were a waste of money. The American Heart Association kept their omega-3 recommendations for heart health, but put more emphasis on omega-3s for people with elevated triglycerides (where the benefits of omega-3s are non-controversial).

Suddenly regarding omega-3 and heart disease, the pendulum is swinging back again. A recent meta-analysis (Alexander et al, Mayo Clinic Proceedings, 92: 15-29, 2017) reported that omega-3s do appear to be beneficial at reducing heart disease risk. An editorial accompanying that article (O’Keefe et al, Mayo Clinic Proceedings, 92: 1-3, 2017) called the meta-analysis “the most comprehensive of its kind to date…” Those experts went on to say “…omega-3-fatty acid intake of at least 1 gram of EPA + DHA per day, either from seafood or supplementation (as recommended by the American Heart Association) continues to be a reasonable strategy.”

This was followed by publication of three clinical studies that came to essentially the same conclusion (Kieber et al, Atherosclerosis, 252: 175-181, 2016 ; Sala-Vila et al, Journal of the American Heart Association, In Press ; and Greene et al, American Journal of Cardiology, 117: 340-346, 2016 ).

Why is there so much confusion about omega-3 and heart disease? Let’s start by reviewing the recently published meta-analysis.


Do Omega-3s Lower Heart Disease Risk?

omega-3 lowers heart disease riskThis study (Alexander et al, Mayo Clinic Proceedings, 92: 15-29, 2017) combined the data from 18 randomized controlled trials with 93,000 patients and 16 prospective cohort studies with 732,000 patients. This was the largest meta-analysis on omega-3s and heart health performed to date. The results were as follows:

  • The combined data from the randomized controlled studies showed that omega-3 supplementation resulted in a non-significant 6% reduction in heart disease risk. This is similar to other recently published studies (more about that later).
  • However, when the investigators looked at high risk populations within the randomized controlled studies, the results were strikingly different.
    • In patients with elevated triglycerides, omega-3 supplementation caused a significant 16% reduction in heart disease risk.
    • In patients with elevated LDL cholesterol, omega-3 supplementation caused a significant 18% reduction in heart disease risk.
  • In addition, the combined data from the prospective cohort studies showed that omega-3 supplementation resulted in a significant 18% decrease in heart disease risk.

The authors concluded “[Our] results indicate that EPA + DHA may be associated with reducing heart disease risk, with greater benefits observed among higher-risk populations…”


Why Is There So Much Confusion About Omega-3s and Heart Disease Risk?

confusionThere are several major clinical studies in progress looking at the effect of omega-3s on heart health. Some experts predict that the confusion will be cleared up once they are published. I predict they will only add to the confusion. Let me explain why.

You’ve heard the old saying “Garbage in – garbage out.”  Proper design of clinical studies is essential. If a study is poorly designed, it provides incorrect information. When you analyze the previous clinical studies carefully, you find that many of them are flawed. Their results are, therefore, incorrect. My fear is that many of the ongoing clinical studies will contain the same flaws and will provide the same incorrect information.

Let’s look at the flaws, and why they provide incorrect information.

Flaw #1: Omega-3 supplementation will only be beneficial for people who are omega-3 deficient. The authors of the Mayo Clinic Proceedings editorial provided a useful analogy. They said: “Vitamin C bestows dramatic and lifesaving benefits to persons with scurvy, but is no better than placebo for persons who are replete with vitamin C.”

That means a well-designed study should measure omega-3 levels in red blood cells both prior to and at the end of the clinical study. The data analysis should focus on those individuals who started the study with low omega-3 status and whose omega-3 status improved by the end of the study. Unfortunately, few of the previously published studies have done that, and I am not confident that the ongoing studies have incorporated that into their experimental design.

Flaw #2: Omega-3 supplementation will be of most benefit for those people who are at highest risk for heart disease. This has been a recurrent pattern in the literature. Many of the clinical studies focusing on high-risk individuals have shown a beneficial effect of omega-3 supplementation on heart disease risk. Most of the studies focusing on the general population (most of which are of low risk for heart disease) have failed to show a benefit of omega-3 supplementation. The current meta-analysis is no exception. When they looked at the general population, there was a non-significant reduction in heart disease risk. However, when they looked at high-risk populations the beneficial effect of omega-3s was highly significant.

I can’t predict how the ongoing studies will analyze their data. If they focus on high-risk groups they are more likely to report a beneficial effect of omega-3s on heart health. If they only report on the results with the general population, they are likely to conclude that omega-3s are ineffective.

I do need to make an important distinction here. The inability to demonstrate a beneficial effect of omega-3 supplementation in the general population does not mean that there is no effect. It turns out to be incredibly difficult to demonstrate a beneficial effect of any intervention, including statins , in a healthy, low-risk population. Because of that, we may never know for sure about the relationship between omega-3 and heart disease. Do omega-3s reduce heart disease risk for the young and healthy. At the end of the day, you will need to make your own decision about whether omega-3s make sense to you.

omega-3 supplementationFlaw #3: Heart medications mask the beneficial effects of omega-3 supplementation. When the public hears about the results of a randomized controlled study they assume that the placebo group received no treatment and the omega-3 group was only receiving omega-3s. That is not how it works.  Medical ethics guidelines require that the placebo group receive the standard of care treatment – namely whatever drugs are considered appropriate for that population group.

That means that it has become very difficult to demonstrate that high-risk populations benefit from omega-3 supplementation. Back in the 90s, the standard of care for high risk patients was only one or two drugs. In those days, many studies were reporting beneficial effects of omega-3 supplementation in high risk populations. However, for the past 5-10 years the standard of care for high risk patients is 4-5 medications.

These are medications that reduce cholesterol levels, lower triglyceride levels, lower blood pressure, reduce inflammation, and reduce clotting time. In other words, the drugs mimic all the beneficial effects of omega-3s. (The only difference is that the drugs come with side-effects. The omega-3s don’t.) It is no coincidence that many of the recent studies have come up empty-handed.

The current studies are asking a fundamentally different question. In the 90s, clinical studies asked whether omega-3s reduced heart disease risk in high-risk patients. Today’s clinical studies are asking whether omega-3s provide any additional benefits for patients who are already taking multiple drugs. Personally, I think my readers are more interested in the first question than the second.

Once again, the current meta-analysis is perfectly consistent with this interpretation. The high-risk groups who clearly benefited from omega-3 supplementation were not ones with pre-existing heart disease or who had previously had a heart attack. They were the ones with elevated LDL cholesterol or triglycerides. They were patients who were, either not taking drugs for those risk factors, or patients for whom the drugs were ineffective.

Because subjects in future studies will be taking multiple medications, I predict that even those ongoing studies focusing on high-risk populations will come up empty-handed.

Now you understand why I started this section by saying that I predict many of the ongoing studies will provide incorrect results. I predict that you will see more headlines proclaiming that omega-3s don’t work. However, you won’t be swayed by those headlines because you now know the truth about the flaws in the clinical studies behind the headlines!

What Does This Mean For You?

omega-3 fish oilThe most recent meta-analysis and a careful evaluation of previous studies make two things clear:

  • If you are at high risk of heart disease, omega-3 supplementation is likely to reduce your risk.

We can divide risk factors for heart disease into those we know about, and those we don’t.

  • Risk factors we know about include previously diagnosed heart disease or heart attack, genetic predisposition, age, elevated LDL cholesterol levels, high triglycerides, high blood pressure, inflammation, obesity, metabolic syndrome and diabetes.
  • Unfortunately, there are also risk factors we don’t know about. For too many Americans the first sign of heart disease is sudden death – sometimes just after receiving a clean bill of health from their doctor.
  • If you are not getting enough omega-3s in your diet, omega-3 supplementation is likely to reduce your heart disease risk.

If you are young and healthy, the unfortunate truth is that we may never completely understand the relationship between omega-3 and heart disease. We may not know whether omega-3 supplementation reduces your risk of heart disease. However, I think the overall evidence is strong enough that you should consider adding omega-3s to your diet.

In short, I agree with the authors of the Mayo Clinic Proceedings editorial and the American Heart Association that omega-3-fatty acid intake of at least 1 gram of EPA + DHA per day, either from seafood or supplementation, is a prudent strategy for reducing heart disease risk.


The Bottom Line

  • There has been a lot of confusion about the role of omega-3s in reducing heart disease risk.
  • In the 90s, several clinical studies reported that omega-3 supplementation reduced heart disease risk. Most experts, including the American Heart Association, were recommending that most Americans would benefit from adding 500-1,000 mg of omega-3s to their daily diet.
  • In recent years, several clinical studies have reported that omega-3 supplementation has no effect on heart disease risk. [There were some important flaws in those studies, which I discuss in the article above]. Experts started saying that omega-3s were overrated. They were a waste of money.
  • The largest meta-analysis ever undertaken in this area of research has recently reported that omega-3 supplementation decreases risk of heart disease in high-risk population groups. Three subsequent clinical studies have come to essentially the same conclusion.
  • Other studies suggest that omega-3 supplementation is also likely to reduce heart disease risk in individuals with poor omega-3 status, and most Americans have poor omega-3 status.
  • We may never know whether omega-3 supplementation reduces heart disease risk if you are young and healthy. Simply put, not enough young & healthy people develop heart disease within the time-frame of a clinical study for the results to be statistically significant. For this group, the old saying about “An ounce of prevention…” just makes sense.
  • I agree with those experts who recommend at least 1,000 mg/day of omega-3s as a prudent strategy for reducing heart disease risk.
  • There are several major clinical trials in progress studying the efficacy of omega-3s for reducing heart disease risk. Some experts predict that the confusion will be cleared up once they are published. I predict they will only add to the confusion. I predict that many of those studies will show no benefit of omega-3 supplementation, and you will see more headlines proclaiming that omega-3s play no role in heart health. If you have read the article above, you won’t be swayed by those headlines because you will know the truth about the flaws in the studies behind the headlines.


These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Latest Article

Calf Cramps Remedy

Posted February 20, 2018 by Dr. Steve Chaney

Don’t Let A Leg Cramp Stop You Short

Author: Julie Donnelly, LMT – The Pain Relief Expert

Editor: Dr. Steve Chaney


calf cramps remedyGetting a leg cramp while you are running can be the “straw that broke the camel’s back.”  If you don’t treat it properly and quickly when it is happening, you may limp to the finish line, and you can suffer from its effects for days afterward.  I will show you the best calf cramps remedy below.  First, let’s go over spasms and muscle cramps.

A spasm and a cramp are similar because it’s a shortening in the muscle fiber, but that’s where the similarity ends. A spasm is a slow-forming shortening of a group of fibers that tie up into a knot in the muscle. You can feel a spasm with your fingertips, it feels like a bump as you slide along the full length of the muscle. With a spasm, as you press down and slide, it doesn’t hurt until you get to the spasm, and then it can really hurt. But then it stops hurting as you slide off the spasm. A spasm refers pain to the insertion points of the muscle and frequently doesn’t hurt where the spasm has formed (that is, until you press on it).

Why Do Your Muscles Cramp?

calf cramps remedy muscle crampsA cramp (Charlie horse) is when all the fibers of the entire muscle suddenly and violently contract. The muscle will quickly shorten and can go into a huge knot, or it will just totally shorten.

Usually a cramp happens in your calf muscle, although it can happen to any muscle in the body.  Your calf is comprised of two major muscles, the gastrocnemius and soleus. The gastrocnemius, which is shown in this graphic, originates behind your knee and inserts into your Achilles tendon.

Visualize the muscle suddenly shortening, pulling up on your Achilles tendon, and becoming a mass of tight knots through the entire muscle.

Muscles have an “all or nothing” response.  This means that when a muscle fiber contracts, it will shorten 100% of its length.  It never starts to shorten and then make a U-turn and lengthen.  A cramp is seriously painful, and if you try to stretch it out as it’s happening, you can tear the muscle fibers. In fact, that’s the reason it hurts for sometimes days after the cramp.

A Calf Cramps Remedy You Can Administer Yourself

calf cramps remedy squeezeThe best thing to do is to squeeze the two ends of your calf muscle together, which will help the cramp complete as quickly as possible. This will hurt, but for less time than the normal cramping process.  Hold your calf tightly, as shown in this picture, and continue to press the two ends toward each other.

Hold it until you can breathe normally (about 30-45 seconds), and then release. Breathe for a minute or so, and then push the two ends together again.  This second time won’t hurt, you are only doing it to make sure that all the fibers have completed the contraction.

calf cramps remedy hold sittingOnce you have stopped the cramp, don’t stretch…yet. You need to flush out the hydrogen ions (AKA lactic acid) that rapidly built-up in the muscle during the cramp.

There are many ways to self-treat your calf. If you are out on the road you can either sit on a bench or lie on the ground and put the sore calf onto your opposite knee.  Press down and hold the pressure for 30 seconds. Then deeply press along the muscle going from the back of your knee toward your ankle.

calf cramps remedy opposite footYou can also use your opposite heel and press deeply, straight into your calf.

Start at the top of the muscle and move down toward your ankle. Stop whenever you come to a point that is especially painful. The point should be close to the area shown in this picture.

Hold the pressure for 30-60 seconds, or until it doesn’t hurt anymore.  Release, and then repeat 2-3 times.

Complete this self-treatment by squeezing your calf muscle, like you are wringing out a wet towel.  This will force blood into your muscle and get your circulation moving again.

Proof That My Treatments Work

I once taught this technique at an Ironman Triathlon during a 15-minute session I was giving to the triathletes.  Several days later a triathlete emailed me and told me that he had a cramp as he was running, and he did the treatment I’d taught him.  It cost him a few minutes (he wasn’t in the top three, so the time loss wasn’t a huge issue) but he was able to get up and get back to running, totally without pain.

About a mile later he got a cramp in the other leg, but he automatically started to just stretch it like he’d always done before.  He ended up limping all the way to the finish line, and days later it was still hurting.  He wanted to let me know that my cramp treatment really worked great.  This was especially helpful because I’d always wondered what body chemistry did to the outcome of treating a cramp, and here I found out that chemistry wasn’t involved in the treatment of the muscle fibers.

What To Do After The Calf Cramps Remedy

If the cramp happens during a race or athletic event, knowing how to stop it, and these quick massage techniques, will get you back into the game. But it hasn’t totally resolved the issue. Finally, when you have the time to be detailed (after the race, in the evening, etc.), it is important to work out all the spasms and then stretch properly.

When you are treating the muscles afterward, I suggest you consider getting an analgesic cream that goes way deep into the muscle fibers. Use it when you are massaging the muscle, but don’t put it on before you play, run, or before/after a shower because it will go too deep into the muscle and burn like crazy. After you do the treatments, use ice &/or arnica gel (get it at a good health food store) to heal the bruised muscle fibers and help with pain and swelling. Arnica is fantastic, it’s an amazing homeopathic remedy that has been around for ages and really works.

Naturally you will also want to make sure you hydrate properly and that your diet, vitamins and minerals are all in balance.

calf cramps remedy bookCramping is a common problem athletes face, but with a little bit of effort you can prevent muscle injury and get back in the race quickly!

You can find the full treatments for your muscle cramps by going to my book, Treat Yourself to Pain-Free Living . This book has treatments for your entire body, from your head to your feet.  YOU are your own Best Therapist!  Stop pain quickly and easily with self-treatments you can do anytime, anyplace.

Wishing you well,

Julie Donnelly

julie donnelly

About The Author

Julie Donnelly is a Deep Muscle Massage Therapist with 20 years of experience specializing in the treatment of chronic joint pain and sports injuries. She has worked extensively with elite athletes and patients who have been unsuccessful at finding relief through the more conventional therapies.

She has been widely published, both on – and off – line, in magazines, newsletters, and newspapers around the country. She is also often chosen to speak at national conventions, medical schools, and health facilities nationwide.


These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.