More than 30 million Americans suffer from high total cholesterol levels, says the Centers for Disease for Control and Prevention. And, almost 75 million of us have high levels of LDL — low-density lipoprotein, also known as the "bad" type of cholesterol. LDL clings to the walls of arteries and, when present in high amounts, can lead to the build-up of fatty plaques that may cause a heart attack or stroke. LDL's counterpart, HDL — high-density lipoprotein, the "good" cholesterol — actively works against LDL by sweeping it from artery walls and transporting it back to the liver, where it's cleared from the body.
When managing cholesterol levels, the goal is to decrease LDL and increase HDL to help reduce the risk of heart attack and stroke. In recent years, there has been some confusion over the best way to keep cholesterol levels in check. The just-released 2015 Dietary Guidelines for Americans may help clear up some of the cholesterol confusion. Unlike previous iterations, the new Dietary Guidelines notably leave out the recommendation to limit consumption of dietary cholesterol to less than 300 milligrams per day. While the 2015 DGAs no longer provide a recommended limit for the consumption of dietary cholesterol (found in animal products such as egg yolks, full-fat dairy and red meat), they do encourage Americans to follow a heart-healthy eating pattern that limits intake of dietary cholesterol, saturated fats and trans fats in favor of polyunsaturated and monounsaturated fatty acids.
Omega-3 fatty acids, a type of polyunsaturated fat, have become synonymous with cholesterol reduction in recent years. Omega-3s are considered essential fatty acids — meaning that, since your body cannot produce them on its own, you must get them from dietary sources. There are three main types of omega-3s: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and alpha-linolenic acid (ALA). EPA and DHA are found mainly in fish and shellfish; ALA comes from plant sources such as flaxseeds and walnuts. The American Heart Association recommends consuming oily fish (such as salmon, tuna and sardines) twice a week to provide your body with enough EPA and DHA, but meeting this recommendation may be difficult for people with certain dietary restrictions or preferences. Although ALA consumption is usually adequate in the typical American diet, the AHA recommends those looking to increase their intake do so by consuming tofu and other soy products, flaxseeds and walnuts (and their oils), and canola oil.
4 Types of Omega-3 Supplements
Although food sources are the preferred way to meet nutrient requirements, omega-3s are also available in supplement form.
- Fish Oil
Americans consume more fish oil than any other non-vitamin/non-mineral supplement on the market. Fish oil supplements are commonly sold in capsule form and contain EPA and DHA. These supplements are well-researched and have been shown to have few side effects, the most common being belching and a fishy aftertaste (although "belch-free" formulations are becoming more and more prevalent). Fish oil is generally safe to consume, although adverse effects such as an increased risk of hemorrhagic stroke have been reported in people who consume greater than 3,000 milligrams — or 3 grams — a day. Many people who take fish oil do so to reduce their cholesterol levels, even though there is little evidence that fish oil is effective in lowering serum cholesterol. However, when taken in moderate amounts, fish oil has been shown to lower triglycerides (another type of fat found in the bloodstream that is harmful at high levels) and reduce inflammation — two additional, and related, heart disease risk factors.
- Krill Oil
Krill oil, which comes from a tiny shrimp-like crustacean, is an up-and-coming alternative to fish oil. While krill oil also contains EPA and DHA, it's more expensive and hasn't been studied as much as fish oil. Some studies have demonstrated that krill oil may reduce total cholesterol and LDL and increase HDL, but more research is needed to confirm its effectiveness as a cholesterol-lowering supplement, as well as its safety.
- Flaxseed Oil
Flaxseed oil, which is generally thought to be safe to use, is often considered as an alternative to fish oil for vegetarians and those concerned about the mercury content of fish oil supplements. Flaxseed contains ALA, which has health benefits of its own independent of EPA and DHA. While ALA can be converted to EPA and DHA, conversion rates vary among individuals and may be unreliably low. While some small studies have demonstrated that it can reduce cholesterol levels, others have shown that it is ineffective in doing so.
- Algal Oil
Derived from marine algae, this is another vegetarian alternative to fish oil. While several small studies have shown that algal oil increases HDL and decreases triglycerides, most studies used high doses of algal oil to achieve those effects. Although it is a sustainable, plant-based source of DHA and EPA, it may not be the most cost-effective option and more research needs to be done to confirm whether its effects are as potent as those of other omega-3 supplements.
If you decide to take an omega-3 supplement to help lower your cholesterol, it is important to note that not all supplements are created equal. Before starting any supplementation regimen, talk with your doctor as certain supplements can interact with medications or other over-the-counter pills you may be taking. Also, be aware that supplements are not regulated by the FDA so you can't be 100-percent sure that the supplements you purchase are going to be as safe and effective as their labels tout. Choosing supplements certified by independent bodies such as NSF and USP can ensure some quality control. And regardless of which supplement you choose, aim to follow the current Dietary Guidelinesrecommendations for a heart-healthy eating pattern to help reduce your risk of heart disease and stroke.