The Consensus: Omega-3 Fatty Acids Decrease Triglycerides

There is a clear expert consensus that omega-3 fatty acids from either fish or supplements can lower triglycerides. The benefit though may be small unless higher doses are used in the range of 2 grams and more each day. This consensus is based on 8 experts answers from this question: Do Omega-3 fatty acids decrease triglycerides?

Triglycerides are a type of fat found in the blood and are the most common form of fat stored in the body. High levels of blood triglycerides contribute to the development of atherosclerosis and are associated with heart disease, heart attacks and stroke. High triglycerides can commonly occur with a collection of factors linked to metabolic syndrome including excess abdominal fat, high blood pressure, high blood sugar levels, and low HDL-cholesterol.

Common causes of high triglycerides include:

• Obesity
• Poorly controlled diabetes
• An underactive thyroid (hypothyroidism)
• Some forms of liver and kidney disease
• Certain medications such as birth control pills, beta blockers, antipsychotics and corticosteroids
• A diet high in highly processed carbohydrates
• Physical inactivity
• Excessive alcohol consumption
• Genetic disorders.

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Omega-3 fatty acids and triglycerides

Diet, exercise and in some cases, medications are the cornerstone of managing high triglycerides. Drinking less alcohol, being active every day, and eating more high-fibre foods and less highly processed carbohydrates and sugar all help.

One common piece of advice is to consume more fish or to consider taking fish oil capsules. Fish oil is high in the long-chain omega-3 fatty acids of EPA and DHA. As several Metafact experts pointed out, there is good evidence for omega-3 fatty acids lowering triglycerides. The most recent Cochrane Review from 2018 on the topic found that they do reduce triglycerides – albeit the benefit was considered small. This should be taken in the context that the same review found that overall fish oil did not make a significant impact on the risk of cardiovascular disease.

As Cristiano Fava from the University of Verona noted, the degree of benefit of fish oil on triglycerides can probably be expected to amount to a fall of 0.11 mmol/L (10 mg/dL) but this reduction is more consistent when the dosage is higher. As an example, a recent clinical trial using 4 grams per day of a highly purified form of EPA decreased serum triglycerides by 20 percent.

How much of a benefit omega-3 fatty acids can have was the subject of a 2015 review where a 9-26 percent reduction in circulating triglycerides was demonstrated in studies where greater than 4 grams per day of EPA/DHA from marine or enriched food sources were used. While a 4-51 percent reduction was found in studies where 1–5 grams of EPA and/or DHA was consumed through supplements.

Brian Ross from the Northern Ontario School of Medicine wrote that not all omega-3 fatty acids are the same and it is the marine forms (EPA and DHA) which have been shown to have a clear reducing effect. The effect of the plant-derived omega-3 fatty acid alpha-linolenic acid (ALA) which is found in foods like flaxseed appears to have little benefit.

Elevated levels of circulating triglycerides are an independent risk factor for developing cardiovascular disease. There is a beneficial effect of long-chain omega-3 fatty acids (specifically EPA and DHA) either from fish or fish oil supplements in helping to lower triglycerides in those at risk of cardiovascular disease.

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