Fish oil supplements do not increase bad cholesterol


IMAGE: The Fatty Acid Research Institute examines the relationship between the omega-3 fatty acids EPA and DHA and the health perspective More

Photo credit: Fatty Acid Research Institute

The Fatty Acid Research Institute (FARI), in collaboration with the Cooper Institute, has published a new research paper on the omega-3 fatty acids EPA and DHA in fish oil and low-density lipoprotein cholesterol (LDL-C).

Omega-3 fatty acids have long been “heart healthy” and are known to lower blood triglycerides (but usually not cholesterol). Recently, however, questions have been raised about one of the two omega-3 fatty acids “fish oil” – DHA (docosahexaenoic acid) – and the possibility that they may actually raise LDL-C levels, the “bad” cholesterol.

There is good evidence that people with very high serum triglyceride levels (> 500 mg / dL) who are treated with high doses of omega-3, i.e. 4 g / day EPA (eicosapentaenoic acid) and DHA, often experience increases in LDL -C whether this occurs in the “real world” in generally healthy people who take fish oil supplements for cardioprotection is not clear.

A recent study by the Cooper Center Longitudinal Study (CCLS) and FARI sheds new light on this question.

Investigators used data from 9253 healthy men and women who had completed at least two preventive medical exams at the Cooper Clinic in Dallas over a 10-year period. These exams routinely included both blood cholesterol tests and measurements of the Omega-3 Index (i.e., EPA + DHA red blood cell (RBC) levels from OmegaQuant Analytics). Questions about the current use of fish oil supplements were also collected.

With that information, the researchers then asked two questions: 1) have people who started taking fish oil supplements between visits noticed increases in LDL-C levels, and 2) have LDL-C levels increased in people who have increased RBC-DHA levels between visits?

It turns out that the answer to both of these questions was “no”. Indeed, a 1 unit increase in RBC-DHA levels was associated with a small (1-2 mg / dL) but statistically significant decrease in LDL-C. And that analysis took into account concurrent changes in background use of cholesterol lowering drugs like statins. This small decrease in LDL-C is not clinically relevant, but this study shows that the use of fish oil supplements in the general population does not adversely affect LDL-C.

Dr. William Harris, President of FARI and co-inventor of the Omega-3 Index, was the lead author of this study. In his view, “these new findings from the CCLS clearly show that people who take fish oil supplements need not worry about adversely affecting their cholesterol levels, as some have suggested.”

He also noted that these results also agree well with the conclusions of a recent opinion published by the American Heart Association on the use of omega-3 fatty acids in the treatment of high triglyceride levels. This important review concluded that there is “no strong evidence that DHA-containing prescription omega-3 fatty acids, used alone or in combination with statins, increase LDL-C in patients with high triglyceride levels.1”.

Dr. Carl Lavie, cardiologist and medical director of the cardiac rehabilitation and prevention program at the John Ochsner Cardiovascular Institute in New Orleans, LA, commented on this paper: “This large Cooper Clinic study shows that RBC levels are not associated with DHA levels LDL cholesterol levels linked (actually lower), and adding omega-3 supplements wasn’t linked to increases in LDL-C either. ”

Dr. Lavie and colleagues recently published data from 40 studies involving over 135,000 participants in the Mayo Clinic Proceedings, indicating that the combined dose of EPA and DHA predicted a reduction in key cardiovascular outcomes2. “These new data from the Cooper Institute compliment the cumulative evidence of the safety and effectiveness of omega-3s from food sources and supplements, including the combination of EPA and DHA,” he said.


Media inquiries:

Bill Harris,
President, FARI


Phone: + 1-913-302-9433



1. Skulas-Ray, AC et al. Omega-3 Fatty Acids Used to Treat Hypertriglyceridemia: A Scientific Opinion from the American Heart Association. Circulation 140, e673-e691 (2019).

2. Bernasconi, AA, Wiest, MM, Lavie, CJ, Milani, RV, and Laukkanen, YES Effect of omega-3 dosing on cardiovascular outcomes: an updated meta-analysis and meta-regression of interventional studies. Mayo Clinic Procedures (2020).

About the Fatty Acid Research Institute (FARI)

The Fatty Acid Research Institute (FARI) is a non-profit research and education foundation. FARI was founded to accelerate the discovery of the health effects of fatty acids, particularly the long chain omega-3 fatty acids EPA and DHA. FARI researchers and scientists will be single-mindedly focused on publishing high quality research studies on the diverse relationships between fatty acid levels and human (and animal) health outcomes. These studies will improve the ability to predict disease risk and, more importantly, suggest ways to reduce risk by changing our diet and / or supplementation regimen.

About the Cooper Institute

The Cooper Institute is dedicated to promoting lifelong health and wellbeing through research, education, and advocacy around the world. Founded in 1970 by Kenneth H. Cooper, MD, MPH, the Cooper Institute translates the latest science into proactive solutions for improving public health. The focus is on research, education and advocacy. Through these initiatives, the Cooper Institute helps people live better, longer lives and “Now, in the future.”

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