Fish Oil

USAGE AND EFFECTIVENESS

Usage	Effectiveness
Hypertriglyceridemia	Effective (Lower triglyceride levels) • Several clinical studies showed that high dose oral fish oil decreased triglyceride levels by 20-50%, fatty liver disease incidence, liver enzyme levels in patients with high triglyceride levels but it was less effective than gemfibrozil (a medicine for high triglyceride levels); while low dose/ non-prescription oral fish oil tends not to lower triglyceride levels to the same degree; more evidence is needed.
Heart Attack	Effective (Prevent narrowing of blood vessel after blood vessel surgery) • Several analyses of clinical studies showed that oral fish oil had prevented the narrowing of blood vessel after 'ballooning' of a blocked blood vessel by 45%; while usage of fish oil for 2 weeks or less than before surgery was ineffective; more evidence is needed.
High Blood Pressure	Mild effectiveness (lower blood pressure in those with at least moderate high blood pressure) • Several clinical studies, including analyses of clinical studies, showed that oral fish oil, with or without beta-blockers and diuretics (high blood pressure medicine), decreased systolic (blood pressure when the blood pumps) and diastolic (blood pressure when the heart relaxes) blood pressure by 2.5-5.5 mmHg and 1.5-3.5 mmHg respectively • Studies showed that oral fish oil did not have additional effects on blood pressure in patients taking ACE inhibitors (high blood pressure medicine). • In cases where patients are receiving calcineurin inhibitors and cyclosporine (medicines to prevent organ rejection after transplant) therapy, several clinical studies, including one analysis of clinical studies, showed that oral fish oil controlled blood pressure in patients; it decreased diastolic (blood pressure when the heart relaxes) blood pressure by 4.5 mmHg in kidney transplant patients and prevented high blood pressure caused by cyclosporine in patients after heart surgery. • More evidence is needed.
Dry Eye	Mild effectiveness (Improve symptoms of dry eye) • Two clinical studies showed that oral fish oil lowered dry eye syndrome risk in women, improved condition, salt content in tears, pain, blurred vision, and sensitivity in patients. • Meanwhile, others showed that oral fish oil did not increase tear volume, eye injury, function of oil glands in the eyes, and symptoms of dry eye in patients; clinical studies may not robust enough. • More evidence is needed to evaluate the effectiveness of fish oil.
Dysmenorrhea	Mild effectiveness (Decrease symptoms of dysmenorrhea) • Several clinical studies showed that oral fish oil reduced pain, use of pain relief medicines, and disruption of daily routine • More evidence is needed • Dysmenorrhea is a condition of extremely or severe cramps during menstruation.
Endometrial Cancer	Mild effectiveness (Lower risk of endometrial cancer) • Two clinical studies showed that dietary intake of fish oil lowered endometrial cancer risk in female patients; but clinical studies is not robust enough (effectiveness of supplemental fish oil is unclear). • More evidence is needed.
Heart Failure	Mild effectiveness (Prevent heart failure) • Several clinical studies, including analyses of clinical studies, showed that oral fish oil prevented heart failure, decreased rehospitalisation by 9%, and improved heart function in patients with heart failure. • In a population study, higher intake of oral fish oil decreased heart failure frequency by 15% in people who did not have heart failure previously. • More evidence is needed.
HIV/AIDS-related High Cholesterol	Mild effectiveness (Mainly lower triglyceride levels) • In one analysis of clinical studies, oral fish oil decreased triglyceride (component of fats) levels by 12-99 mg/dL; meanwhile, while the same analysis showed that total cholesterol level was reduced by 14 mg/dL in HIV patients with high cholesterol levels, and has an equal effectiveness as statins (medicinal preparation for high cholesterol). • Other studies showed that oral fish oil may not lower total cholesterol levels in HIV patients with high cholesterol level. • More evidence is needed.
Kidney Dialysis	Mild effectiveness (Prevent side effects after graft placement) • Several clinical studies, including two analyses of clinical studies, showed that oral fish oil decreased incidence of clogged blood vessels due to blood clots and blood vessel surgery by 19-29% in dialysis patients with graft (a plastic tube that connects the vein and artery) malfunction. •More evidence is needed.
Kidney Diseases	Mild effectiveness (Improve kidney function for IgA Nephropathy) • Several clinical studies showed that oral fish oil delayed the rate of kidney function deterioration and decreased high protein levels in the urine in kidney disease patients with high IgA (antibody) levels; oral fish oil may not reduce the loss of kidney function in patients using fish oil for short duration, or low dose fish oil; oral fish oil also may not work in patients without protein in urine; more evidence is needed. • IgA Nephropathy is a kidney disease caused by immune system disorder.
Nonalcoholic Fatty Liver Disease	Mild effectiveness (Lower fat content in the liver) • Several analyses of clinical studies showed that oral fish oil decreased liver injury indicator, amount of liver fat, and severity of fatty liver in adults and children with nonalcohol fatty liver disease; but clinical studies are not robust enough (small study size) • More evidence is needed. • Nonalcoholic Fatty Liver Disease is a condition where excess fats are accumulated in the liver of individuals who drink little to no alcohol.
Organ Transplant Side Effects	Mild effectiveness (Preserve kidney function in patients on cyclosporine therapy) • Several clinical studies showed that oral fish oil improved kidney filtration rate, blood flow, kidney function in patients after kidney transplant with or without organ rejection. • More evidence is needed.
Pancreas Inflammation	Mild effectiveness (Improve inflammation of the pancreas) • Several clinical studies showed that fish oil injections decreased the duration of kidney replacement therapy in patients with severe short term pancreas inflammation; improved organ impairment and duration of hospitalisation; but clinical studies are not robust enough (effectiveness of oral fish oil is unknown). • More evidence is needed.
Rheumatoid Arthritis	Mild effectiveness (Decrease pain and stiffness) • Several clinical studies showed that oral fish oil shortened the period of stiff and tender joints, decreased usage of pain relief medication, and speed up recovery; fish oil injections decreased joint swelling and pain, improving the condition in patients with rheumatoid arthritis. • More evidence is needed.

General Safety

• Generally safe when used orally and appropriately as an oral supplement where impurity is filtered; generally safe when used as injection for a short term; avoid taking dietary sources such as salmon and tuna in large amount due to pollutants such as dioxin and mercury; regular intake via dietary source should also be avoided.

Pregnant/Breastfeeding

• Generally safe when used orally and appropriately as an oral supplement where impurity is filtered. Avoid dietary sources such as salmon and tuna due to pollutants such as dioxin and mercury.

Children

• Generally safe when used appropriately as an oral supplement where impurity is filtered. Avoid dietary sources such as salmon and tuna due to pollutants such as dioxin and mercury.

Elderly

• With regards to usage of Fish Oil as a supplement, there is little data to show it is safe or otherwise; as food, avoidance of dietary sources such as salmon and mackerel is advised due to contamination with substances such as mercury.

Special to Note

• Unknown.

Contraindications

• Details:
  • May worsen condition in individuals with bipolar disorder.
  • May increase bleeding episodes in individuals with cirrhosis.
  • May increase blood sugar levels in individuals with type 2 diabetes.
  • May increase cancer risk in individuals with colon polyps.
  • May suppress immunity in immunocompromised individuals.
  • May increase risk of irregular heart rate or rhythm in individuals with implantable defibrillator - a device that is implanted to monitor and regulate heart rate.
  • May cause allergy reaction in individuals with seafood allergy.

Side Effects

• Generally safe; side effects may include:
  • Heart:Oral fish oil may cause higher bad cholesterol levels and irregular heart rhythm
  • Skin:Oral fish oil may cause rashes, itchiness, irritation; A rare case of severely inflammed tissue and death of breast tissue when fish oil was injected
  • Oral fish oil may cause stomach upset, diarrhoea, indigestion, acid reflux, heartburn, bloating, stomach pain, stomach discomfort, anorexia, constipation, nausea, vomiting, fishy hiccups, metallic taste, fish breath, and gastric inflammation
  • Blood:Oral fish oil may cause increased risk of bleeding and stroke; A rare case of red blood cells destruction, causing low red blood cells count
  • Liver:Oral fish oil may cause decreased liver function
  • Immune System: In a rare case, it caused a female patient with crab allergy anaphylaxis, a serious and dangerous allergy with symptoms such as breathing difficulty and low blood pressure; it may also cause decreased immunity
  •Brain/CNS:Oral fish oil may cause headache, dizziness, and sleep difficulty; Rare cases of restlessness and insect crawling sensation on the skin
  • Respiratory System:Oral fish oil may cause upper airway tract infections, asthma, breathing disruption during sleep, and cold
  • Others:May caused increased body weight

• Medicines
  Low to Medium severity interaction with medicines for blood thinning, lowering blood pressure, birth control, organ transplant, lowering body weight, and cancer treatment.
• Supplements
  Low to Medium severity interaction with Herbs and Supplements for blood thinning and lowering blood pressure; containing vitamin D and vitamin E.
• Food
  None known.
• Lab Tests
  None known.

• Oral (Adults)
  6 grammes daily, for up to 3 months.

• General Information
  • While there is a lack of clinical studies, Fish Oil is used by consumers for high blood pressure, heart failure, eczema, and others.
• How does it work?
  • Contains chemicals that reduce asthma attacks, allergy reactions, inflammation, and others.