Omega-3s and Heart Health: What You Need to Know

Michelle Routhenstein, MS, RD, CDE


September 1, 2023

There are a lot of misunderstandings around fat, which has led to it being demonized over the years. But while some types of fat are better kept to a small portion of your diet, there is one type that has been shown to be especially heart-supportive: omega-3s.

The Western diet tends to be high in saturated and trans fats from things like fried, oily, and fast food items. It’s also easy to eat a heavy amount of omega-6 fats in vegetable oils, which aren’t inherently bad but do need to be balanced with heart-healthy omega-3s. 

Where do omega-3s come from and why are they so good for your heart? Let’s examine the importance of omega-3s for heart health and how to make sure you’re getting enough. 

Understanding Omega-3 Fatty Acids

Omega-3s are a type of unsaturated fatty acid. Your body cannot produce them, so you have to consume them through your diet. 

Omega-3s play an important role in supporting eye, heart, and brain health as well as reducing inflammation and making hormones. Every cell in your body needs them for optimal health and function.

There are three main omega-3s: ALA, EPA, and DHA. I’ve broken down the need-to-knows about each one. 

ALA (alpha-linolenic acid)

ALA is found in higher-fat plant foods like chia seeds, flax seeds, and walnuts. It’s the precursor to EPA and DHA, meaning that your body can produce the latter two from the ALA you eat. 

However, the conversion rate from ALA to the others is very low — thought to be less than 5% to EPA and less than 0.5% to DHA. So while incorporating a variety of ALA foods in your diet is a great start, it’s important to also get direct sources of EPA and DHA. 

DHA (docosahexaenoic acid)

DHA is a major structural component of the cells in your eyes and nervous system. In fact, it makes up around 40% of the polyunsaturated fatty acids in your brain. 

DHA is predominantly found in seafood and fish, but not all fish are a good source of omega-3s. Stick to the higher-fat fish species, such as wild salmon, bluefin tuna, herring, lake trout, striped bass, sardines, and mackerel.

You can also find DHA in microalgae, which is where it originates in the ocean and is eaten by sea life.

EPA (eicosapentaenoic acid)

EPA is primarily used by your body to make signaling molecules called eicosanoids. These are involved in your inflammation response process. Getting enough EPA may also be beneficial for supporting a healthy mood.

The best places to find EPA are fatty fish, fish oil, and seafood.

Why Your Heart Loves Omega-3s

Eating omega-3 foods is a great way to show your heart some love because:

  • They help reduce high triglycerides and cholesterol. If you’ve asked, does fish oil lower cholesterol, the answer is that it depends but it can. Omega-3s (which are rich in fatty fish) have been shown to help lower high levels of blood fats, particularly triglycerides. Research suggests that adequate omega-3 intake can impact cholesterol levels in a way that supports heart health. However, it may also depend if you carry the ApoE4 gene.
  • They help support healthy blood pressure. Some studies have found that adequate omega-3 intake can have positive effects on high blood pressure.
  • They offer anti-inflammatory activity. Omega-3s are natural anti-inflammatory agents. Systemic, unmanaged inflammation has been associated with a higher risk for numerous diseases, including heart disease. 

Omega-3s in Prevention and Management

Consuming foods rich in ALA, EPA, and DHA is a great way to be proactive and help lower your risk for heart problems. 

Research also shows that omega-3s can significantly reduce the risk of sudden cardiac death caused by arrhythmias and death from all causes among people who have existing coronary heart disease. A recent review also found that omega-3 supplementation can help reduce the risk of recurrent hospitalizations for heart failure. 

However, it’s important to note that not all omega-3 supplements are created equal and come with risks. It’s possible for omega-3 supplements to interact with certain medications, such as blood thinners, due to their ability to reduce platelet activity. Omega-3 supplements may increase the risk for Afib and mega-dose omega-3s are not advised for most people. Before starting an omega-3 supplement, discuss the options with your healthcare team, including a cardiovascular dietitian.

Furthermore, omega-3s alone can’t prevent or treat heart disease. It’s important to practice other healthy lifestyle habits. Regular physical activity, stress management, maintaining a healthy weight, getting enough sleep, and a science based, nutrient sufficient heart healthy diet are all necessary to optimize heart health. 

Recommended Omega-3 Intake and Ratio

There’s no RDA for omega-3s, but the Institute of Medicine has established an adequate intake (AI). An AI is determined when there’s not enough evidence to develop an RDA and takes into account how much of a nutrient is presumably enough to ensure nutritional adequacy. 

The AI for total omega-3s is 1.6 grams per day for adult men and 1.1 grams per day for adult women, with slightly higher needs during pregnancy and lactation. 

The World Health Organization (WHO) and the European Food Safety Authority (EFSA) recommend getting a minimum of 250–500 mg of combined EPA and DHA per day.

However, surveys suggest that the average dietary intake among Americans is more like 90 mg per day.

As you’re increasing your omega-3 intake, consider your omega-6 intake as well. The majority of the omega-6s consumed in the United States come from vegetable oils, and the high consumption rate can be pro-inflammatory. Hence, when the ratio between omega-3s and 6s is imbalanced — eating significantly more omega-6 than omega-3 — it can promote inflammation and a higher risk of disease. 

So what is the ideal ratio? Researchers think that before food became industrialized, humans were eating around a 4:1 ratio of omega-3 vs omega-6. Other evidence suggests that we were once thriving on closer to a 1:1 ratio, whereas today we’re eating about 16 times more omega-6s than omega-3s. 

Incorporating Omega-3s into Your Diet

There are two main ways to add more omega-3 to your diet: omega-3-rich food and omega-3 supplements. 

Boost omega-3s through food intake by: 

  • Eating grilled, baked, or roasted fatty fish like salmon, sardines, tuna, or mackerel at least twice per week
  • Add walnuts to your oatmeal, homemade trail mix, or salad
  • Toss chia or flax seeds into smoothies and yogurt bowls
  • Snack on edamame (soybeans) or add them to stir-fries and grain bowls
  • Use small amounts of canola, flax, or walnut oil when making homemade salad dressings

You might also be considering a supplement, especially if you’re not a big fan of fish and seafood. Is omega-3 the same as fish oil? Not necessarily. Fish oil is a source of omega-3s, but not all omega-3 supplements are fish oil. You can also find krill oil and algae oil supplements that contain DHA and EPA. 

Please note that high-dose fish oil supplements are not indicated for everyone. There is some evidence that using these can actually lead to atrial fibrillation, particularly if started following a heart attack. They may also result in an increase in LDL “bad” cholesterol for some. Along this same line, individuals who already have Afib or high LDL should focus on dietary sources of omega-3s rather than adding a fish oil supplement. 

Final Thoughts on Omega-3s and Your Heart

Most of us aren’t eating enough omega-3s, which have been proven to offer heart health benefits. It’s best to prioritize whole food sources of omega-3s first, as supplements are not appropriate for everyone. Add foods like fatty fish, seafood, walnuts, chia, and flax seeds. And always work with your cardiovascular dietitian for individualized heart health recommendations. 

It can also be helpful to work with a cardiovascular registered dietitian to evaluate your diet and see where positive changes can be made. You can learn more about my 1 on 1 services here or my 6 week heart optimization group coaching course here.


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