What is the connection between fish oil and cholesterol?

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Nearly every "x steps to lowering cholesterol" article recommends fish oil; either by consuming fish rich in omega-3 fatty acids and/or taking fish oil supplements containing the fish oils EPA and DHA (eicosapentaenoic and docosahexaenoic acids). But why? Just what are omega-3 fatty acids and how do they reduce cholesterol? And who should consider taking EPA and DHA fish oil pills?

What Are Omega-3 Fatty Acids?
According to the American Heart Association, "Omega-3 (n-3 polyunsaturated) fatty acids are essential fats that your body needs to function properly but does not make. Humans must eat them through food, which means getting EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) from seafood, such as salmon, tuna, sardines, mackerel or shellfish, and ALA (alpha-linolenic acid) from sources such as walnuts, flaxseed, and canola and soybean oils. Omega-3 fatty acids, particularly EPA and DHA, have been shown to benefit the heart of healthy people and those at high risk for - or who already have - cardiovascular disease. Research has shown that omega-3 fatty acids decrease risk of arrhythmias (abnormal heartbeats), which can lead to sudden death. Omega-3 fatty acids also decrease triglyceride levels, slow growth rate of atherosclerotic plaque, and lower blood pressure (slightly)."

Is It Better To Eat Fish or Take Fish Oil Supplements?
People without heart disease already should eat a variety of fish (preferably oily fish like salmon, tuna, mackerel, herring and trout) at least twice a week, according to The American Heart Association. Ideally, this should be in place of high fat foods, and as part of a low-fat, heart-healthy diet.

Who Should Take Fish Oil Supplements?
Eating a diet rich in omega-3 fish oils is important for everyone. However, this may not be enough for those with high triglycerides. For people with high triglycerides, the recommendation from the American Heart Association is two to four grams of EPA and DHA per day provided as capsules, under a physician's care.

Which to take, Rx or OTC?
Approved by the FDA to lower triglycerides, the prescription fish oil supplement Lovaza contains 465 milligrams of EPA and 375 milligrams of DHA in 1-gram capsules.Non-prescription fish oil pills contain far less EPA and DHA than Lovaza. Since these over-the-counter supplements are classified as food (as opposed to as a drug), they are not monitored by the FDA so may contain contaminants like mercury. Speak with your doctor about which is best for you.

How Do Omega-3 Fatty Acids and Fish Oil Supplements Reduce Cholesterol?

In fact, omega-3 fatty acids don't actually reduce cholesterol. Rather, they reduce triglycerides and lower coronary heart disease risk. The Discovery Fit&Health site's How Fish and Fish Oils Lower Cholesterol article explains that, "The omega-3 fatty acids, DHA and EPA, in fish are thought to prevent irregular heartbeat (arrhythmia), reduce inflammation and the risk of blood clots, decrease high triglyceride levels and blood pressure, and modestly improve HDL cholesterol."

What About Fish or Fish Oil Contaminants?
While it is true that there can be contaminants like PCBs and mercury in fish and fish oil supplements, the American Heart Association says the benefits far outweigh the risks. "For middle-aged men and for post-menopausal women, the benefits of eating fish a few times per week far outweigh the potential risks. As fish consumption increases, the number of fatal cardiovascular events decreases and the cardiovascular benefit increases. However, four specific fish species (shark, swordfish, king mackerel, and tilefish) should be avoided to minimize exposure to mercury. In addition, albacore tuna can be eaten but should be limited to six ounces (one average meal) per week."

According to WebMD article 11 Tips to Cut Your Cholesterol Fast, "Fish oil is considered to be quite safe, but check with your doctor first if you are taking an anti-clotting medication."

Everyone should strive to eat omega-3 fatty acid rich foods like salmon, tuna, mackerel, herring, and trout twice a week. The omega-3 fatty acids found in these kinds of fish (and in fish oil supplements) are especially important to battle high triglycerides and offer some coronary heart disease prevention to those with high cholesterol and/or at risk for coronary heart disease.
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