Does fish oil really lower cholesterol and what is the best way to take it?

The effect of fish oil on cholesterol

Fish oil contains vitamins A, E, D and monounsaturated and polyunsaturated fatty acids (PUFAs): docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These substances make fish oil an indispensable anti-cholesterol agent and have a complex effect:

• reduce the level of triglycerides in the blood;
• regulate the amount of cholesterol;
• strengthen the walls of blood vessels and clear them of LDL plaques;
• reduce blood clotting;
• increase the lumen of the arteries.

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Additionally, PUFAs are involved and have a beneficial effect on processes such as:

• retinal protection;
• improving blood circulation in the brain, muscle mass, and functioning of the reproductive system;
• restoration of nerve fibers;
• prevention of the development of Alzheimer's disease;
• normalization of the emotional background due to the production of serotonin;
• prevention of degenerative diseases of the nervous system;
• increasing immunity.

Watch a video about how fish oil acts on the body with high cholesterol:

HOW TO LOWER CHOLESTEROL AND STRENGTHEN BRAIN VESSELS WITH FISH OIL.

Effect on the liver and cardiovascular system

Another scourge of recent decades, especially in developed countries, is high blood pressure. Unfortunately, at the moment the principle of reducing pressure has not been established by scientists. Most of all, doctors are inclined to believe that to maintain the health of the body, the correct ratio of Omega-3 and Omega-6 fatty acids is necessary. The optimal ratio is 1:1, but the actual result is 16:1. Consuming fish oil is a relatively simple and inexpensive way to improve this indicator.

As already mentioned, fatty acids affect the entire cardiovascular system, thin the blood, reduce platelet aggregation, and this is an excellent prevention of heart attacks, strokes, coronary heart disease and other heart diseases. Omega-3s are beneficial for blood vessels, which means they reduce the likelihood of atherosclerosis, varicose veins and thrombosis.

In addition, when consuming fish oil, the body produces enzymes that have a positive effect on the liver. Fish oil also cleanses the kidneys and liver, our biological filters, of waste and toxins.

Indications for high cholesterol

The drug is prescribed in the following cases:

• prevention and treatment of atherosclerosis;
• prevention of relapses after myocardial infarction;
• complex therapy of pathologies that are accompanied by an increase in the level of LDL in the blood;
• relief of ischemic lesions of the heart and brain against the background of previously diagnosed atherosclerosis.

Note! For prevention, fish oil can be prescribed if there are cases of atherosclerosis in the family or clinical history.

Price

The impressive range of prices for fish oil in pharmacies is due to the different values ​​of the raw materials: the production of nutraceuticals from krill and fish meat is more expensive, and this is reflected in the cost of the finished product.

Russian companies mainly produce fish oil from cod liver, which is why the prices for their products are very affordable.

The degree of purification plays a big role in pricing. According to international environmental standards, there are three groups of nutraceuticals:

1. Cheap fish oil from cod liver with a low level of purification. The most widely available option is represented by Russian-made products - for 29-30 rubles you can buy 100 capsules of 300 mg each, without additives (oil solution - at a price of 30-33 rubles per 50 ml).
2. Middle-class products are also not devoid of impurities, they are made from liver, but have a higher content of PUFAs - for 170-190 rubles they buy 30 capsules of 1400 mg each, they can contain antioxidant tocopherols (210 rubles are paid for 50 ml of a saturated solution).
3. Exceptionally purified products from krill, fish meat and cod liver with a high content of PUFAs - the Israeli company TEVA sells 100 capsules of 500 mg at a price of 998 rubles, the Russian Polaris - 30 capsules of 1 gram for 211 rubles, the Icelandic company Möller's - 250 ml of solution for 1350 rubles

Thus, in pharmacies you can buy fish oil for every taste and budget.

Contraindications for high cholesterol

Taking fish oil for high cholesterol levels is not recommended if the patient has a history of the following indications:

• sensitivity to fish products;
• cholelithiasis and/or urolithiasis;
• increased levels of calcium in the blood;
• formation of calcifications in tissues;
• disorders of the thyroid gland;
• chronic gastrointestinal pathologies in the acute stage;
• active form of tuberculosis.

Under the strict supervision of the attending physician, omega is prescribed in the following cases:

• pregnancy and breastfeeding;
• decreased blood clotting;
• low blood pressure;
• taking oral contraceptives, antiplatelet agents, antihypertensive drugs.

Benefits for the body

Direct indications in the instructions for use of fish oil are:

• hyperlipidemia;
• prevention of atherosclerosis, vascular thrombosis.

However, if used correctly, one can also attest to some of its key advantages:

• it lowers blood pressure;
• suppresses inflammatory processes;
• prevents degenerative changes in the retina;
• activates cerebral blood flow;
• improves connections between neurons;
• promotes the development of muscle mass during physical education;
• stimulates the synthesis of a natural antidepressant - the hormone serotonin;
• optimizes reproductive functions of both sexes.

Its general effect on the body is manifested in strengthening the immune defense.

Reception features

For high cholesterol levels, drink 5 g of fish oil daily. If the dosage is exceeded, it is 3 g per day, prophylactic - 1-2.

The daily intake of capsules is calculated based on the concentration of PUFAs, which is indicated in the annotation. The resulting amount is divided into 2-3 doses. Take capsules during or after meals with water. The duration of the course is determined by the doctor individually - 4-8 weeks.

Liquid fish oil for cholesterol is taken 1 tablespoon per day with meals. The dosage is approached gradually - for the first 3-4 days they drink a teaspoon, then for 3 days - a dessert spoon, then take a full portion.

Attention! If a person experiences intense physical activity, the doctor may double the dosage.

How to choose a quality product?

Fish oil is a very capricious oil solution: it quickly oxidizes, becomes rancid, and harmful substances are formed in it - free radicals. Therefore, when purchasing a nutraceutical, several points are taken into account.

• The product with PUFA content of more than 15% has the greatest value. They are calculated by adding the DHA and EPA values ​​and then dividing the sum by 100.
• Oil from krill and muscle fibers of valuable fish species is highly valued; the product from cod liver is somewhat inferior to it.
• The liquid form of a quality product is sold in bottles only made of dark glass (not plastic).
• The correct nutraceutical consists exclusively of fish oil, and only gelatin is added to the capsules, avoiding the presence of aromatic and other synthetic additives.
• A quality product is purified by molecular distillation or differentiation, as mentioned on the packaging or in the annotation.

At home, they check its quality organoleptically: they cut one capsule, evaluate it visually, smell it and taste its contents. A foul-smelling, rancid substance will indicate a violation of the manufacturing technology and the danger of its use.

Overdose and side effects

Fish oil lowers cholesterol, but it can also cause a number of side effects:

• stool disorder;
• flatulence;
• belching with a fishy taste;
• the appearance of rashes;
• change in heart rate.

If the recommended dosages are followed, side effects rarely occur, and only in cases of individual sensitivity to the active substance. In this case, you need to consult a doctor to change the drug, release form or adjust the daily dose.

Often patients, guided by the fact that fish oil reduces cholesterol levels in the blood, begin to exceed the recommended amount to achieve a quick effect. Such self-correction can lead to an overdose. Fish oil thins the blood, which increases the likelihood of bleeding. An overdose may also cause chest pain, an allergic reaction, or a feeling of heat or chills. If such signs appear, you should immediately consult a doctor.

Interesting facts from the history of fish oil

Since the first centuries of our era, peoples living on the coasts of the seas and oceans have eaten fat obtained from fish, even instead of vegetable oils. Famous sailors and travelers wrote in their diaries that these peoples were distinguished by good health and longevity.

The Norwegian pharmacist Peter Meller began to closely study the problem in the mid-19th century. Observing the inhabitants of the coast of Norway, he came to the conclusion that they were distinguished by good health due to the daily consumption of oil obtained from cod liver.

This fact prompted the scientist to start producing cod oil and selling it to the public through pharmacies. Since then, fish oil has found its way into the pharmacopoeia of Europe and then other countries.

What is fish oil obtained from and its composition?

The product is extracted from the liver of cod, mackerel, herring, stingrays, sharks and other fatty species of sea fish that live in cool waters. Authentic cod oil in its purest form is now produced in its homeland in Norway.

Fish oil contains the following beneficial components for the body:

• polyunsaturated fatty acids – omega-3, omega-6;
• high density cholesterol;
• microelements – fluorine, bromine, iodine, phosphorus;
• biologically active substances amines that stimulate metabolic processes in tissues;
• fatty pigments lipochromes are analogues of plant carotenoids, are antioxidants and participate in the synthesis of vitamin A;
• fat-soluble vitamins A and D.

An important property of fish oil is its ability to rapidly oxidize. That is why it is almost completely absorbed in the body and is not stored “in reserve” like other oils.

Polyunsaturated fatty acids of the ω-3 class in the prevention and treatment of atherosclerosis

The basis of primary and secondary prevention of atherosclerosis is the concept of risk factors for the development of this disease, among which the leading role is assigned to atherogenic dyslipidemia. The latter imply a violation of the lipoprotein spectrum of the blood: an increase, decrease or absence of one or more classes of lipoproteins, which leads to the development of atherosclerosis [1, 2]. A decrease in the level of anti-atherogenic high-density lipoprotein (HDL) and an increase in the level of atherogenic low-density lipoprotein (LDL), as well as lipoprotein (a), play a primary role in the development of atherosclerosis. Hypertriglyceridemia also increases the risk of atherosclerotic vascular damage, while increased blood triglyceride levels in women are a more significant risk factor for coronary heart disease (CHD) than in men [3, 4].

Endothelial dysfunction plays a special role in the development and progression of atherosclerosis. The pathological process is based on damage to the endothelium by oxidized LDL, while the damaged endothelium loses the ability to produce a vasodilating factor (nitric oxide), resulting in vascular spasm in the damaged area (J. Deanfield, 1997). Modified lipoprotein particles acquire autoantigenic properties and trigger a cascade of autoimmune reactions that cause the development of inflammation in the vessel wall [5]. By reducing LDL levels, endothelial function is restored. In turn, HDL prevents the damaging effects of oxidized LDL.

Violation of the functional state of platelets plays an important role in atherogenesis as a factor that not only provokes the development of thrombosis, but aggravates endothelial damage, microcirculation disorders and the formation of atherosclerotic plaque. The blood coagulation system is activated and fibrinolysis is inhibited, which is essential in the development of coronary artery disease and its complications [6].

Arterial hypertension is another primary and very important risk factor for the development and progression of atherosclerosis in both women and men, while, according to the Framingham Study, systolic blood pressure (BP) plays a more significant role than diastolic [7].

Activities aimed at primary and secondary prevention of atherosclerosis should include:

• normalization of LDL and HDL levels in the blood;
• correction of hypertriglyceridemia;
• elimination of endothelial dysfunction;
• elimination of microcirculation disorders;
• stabilization of blood pressure.

Population studies conducted by Dyberg (1981) on Greenlandic aborigines, as well as in other populations with a similar lifestyle and diet in different countries (Holland, Japan), compared the incidence of cardiovascular diseases in patients who used a fish diet with other categories population. Studies have shown that the former have significantly lower morbidity and mortality rates from coronary artery disease. It has been proven that the effectiveness of “marine” diets depends on the polyunsaturated fatty acids of the ω-3 class (ω-3 PUFAs) included in marine products: eicosapentaenoic acid (EPA) and decosahexaenoic acid (DHA). These fatty acids are not synthesized in the human body and are considered essential.

The blood plasma of Eskimos contains higher amounts of EPA and DHA than that of Western Europeans. Analysis of the results of population studies, which compared the nutritional characteristics of the subjects and the incidence of cardiovascular diseases in them, marked the beginning of a new direction in modern dietetics associated with the use of fish products and tissue fish oil.

Experimental study of the effects of PUFA ω-3

The mechanisms of the positive effect of ω-3 PUFAs on atherogenesis have not been sufficiently studied. It is known that arachidonic acid is the most important precursor for the biosynthesis of eicosanoids (biologically active substances formed as a result of the metabolism of arachidonic acid: prostaglandins, leukotrienes, thromboxanes, etc.), which are the most important regulators of cellular processes [8]. Due to their structural similarity, arachidonic acid, EPA and DHA are natural competitors. Their metabolism is so interconnected that when nutritional conditions, intake, and, as a result, the content of one class of PUFAs in the body changes, the level of other classes also changes. When there is an excess of ω-3 PUFAs in the diet, EPA and DHA replace arachidonic acid in the phospholipids of cell membranes, which leads to a change in the qualitative composition of eicosanoids: the synthesis of series 3 eicosanoids, which differ in their action from those formed during the metabolism of arachidonic acid [9]. Thus, as a result, the production of thrombogenic thromboxane A2 is inhibited, instead of which thromboxane A3 is formed, which is physiologically much less active, which reduces platelet aggregation. Prostaglandin I3 is synthesized from EPA, which has a pronounced vasodilating effect. EPA reduces the production and activity of inflammatory mediators, in particular leukotriene B4, and stimulates the formation of leukotriene B5 with significantly less pro-inflammatory activity. The inclusion of DHA in the lipids of endothelial and vascular intimal cells inhibits the adhesion of leukocytes, thereby reducing the severity of the inflammatory response [10].

The effect of ω-3 PUFA on blood lipids has been studied in numerous experimental studies. Experiments on rats whose diet was supplemented with fish oil showed a decrease in the levels of phospholipids, triglycerides and cholesterol in the blood. In parallel with the decrease in triglyceride concentrations, the activity of lipoprotein lipase in the blood plasma and liver lipase decreased, which was considered as a physiological adaptive response to a decrease in the substrate content [11, 12, 13]. Experiments with hepatocyte cell culture showed the inhibitory effect of EPA on the biosynthesis of triacylglycerides [14].

There is evidence that a diet rich in ω-3 PUFAs inhibits the oxidation of modified LDL, thereby preventing endothelial damage and inhibiting atherogenesis [15].

Increasing dietary ω-3 PUFA content quickly affects platelet lipid composition. This is accompanied by a decrease in the production of thromboxane A2 and a decrease in adenosine diphosphate-induced platelet aggregation [16, 17]. Along with a decrease in the degree and rate of platelet aggregation, when ω-3 PUFAs are introduced into the diet of laboratory animals, the bleeding time also lengthens. However, published materials indicate significant variability in this indicator and its change to varying degrees under the influence of a diet enriched with ω-3 PUFAs [18].

A separate group consists of experimental studies that studied the effect of ω-3 PUFAs on blood pressure levels. It was shown that the use of fish oil prevented an increase in blood pressure during salt loading in rats [19]. EPA inhibits the action of the neuropeptide, thus being an antagonist of the sympathetic effect on peripheral vessels [20, 21]. The works of F.Z. Meerson and co-authors (1998) established a decrease in vasoconstrictor effects and an increase in vasodilation under the influence of ω-3 PUFAs.

DHA, which is part of the phospholipids of synaptic membranes, is necessary to ensure normal control of blood pressure levels. Its inclusion in synaptic membranes occurs in the perinatal period. JA Armitage et al (2003) in an experimental study on Sprague–Dawley rats examined the importance of perinatal administration of ω-3 PUFAs to ensure the functioning of control mechanisms in adult rats. Pregnant uteruses were fed a semisynthetic diet deficient or supplemented with ω-3 PUFAs. In the offspring, at the 33rd week, the mean blood pressure in the femoral artery was determined by a direct method. In rats with ω-3 PUFA deficiency, the level of mean blood pressure was significantly higher (≈ by 17 mm Hg). Thus, insufficient levels of DHA during the perinatal period are subsequently associated with disturbances in the regulation and control of blood pressure. Hypertension in adults may result from perinatal ω-3 PUFA deficiency.

An increase in the ratio of arachidonic acid to DHA in cardiac phospholipids in rats fed a corn oil diet resulted in increased episodes of ventricular fibrillation and sudden death. The inclusion of fish oil in the diet of animals was accompanied by a decrease in this ratio and the frequency of deaths. ω-3 PUFAs, when included in the diet, significantly reduce the incidence of ventricular fibrillation and mortality in rats with acute myocardial infarction, and prevent the development of ventricular arrhythmias during acute myocardial ischemia and reperfusion. Fish oil increases endothelial relaxation of the coronary arteries and aorta, reduces the ratio of ω-6 PUFA/ω-3 PUFA in cardiomyocytes. This leads to a decrease in adenosine triphosphatase activity and calcium transport.

As a result, the sensitivity of cardiomyocytes to rapid changes in calcium concentration, characteristic of myocardial ischemia, decreases [22].

Thus, experimental studies of ω-3 PUFAs revealed their hypolipidemic, hypocoagulative, vasodilating, hypotensive and cardioprotective effects, which served as the basis for their use in clinical practice.

Application of ω-3 PUFAs in clinical practice

Sources of ω-3 PUFAs are:

• food products containing different (depending on origin, season, etc.) amounts of ω-3 PUFAs: whole fish and seafood;
• food supplements, as a rule, standardized by the total content of ω-3 PUFAs;
• medicinal products standardized for each component of ω-3 PUFA and with their high content.

In fish diets, the most widely used are mackerel and salmon, 130–800 g daily. Nutritional supplements in the form of capsules containing ω-3 PUFA concentrate are more convenient for use.

In most cases, the capsules contain an antioxidant (for example, 1 mg of tocopherol) and a flavoring agent that suppresses the odor of fish oil. Long-term adherence to such diets leads to a decrease in the level of triglycerides and total cholesterol, and increases the content of EPA in blood lipids.

It is known that the incidence of stroke in women increases sharply with age, doubling after age 55 every decade (RL Sacco et al., 1997). H. Iso et al (2000) observed 80,000 middle-aged American women for 14 years.

Those who ate sea fish 2-3 times a week had a 2-fold lower incidence of stroke compared to women who did not eat fish. However, there was no increase in the incidence of hemorrhagic strokes in those who ate fish 5 or more times a week. Shekelle et al (1985) observed a group of 1931 men for 25 years who had no clinical symptoms of coronary artery disease at the time of inclusion in the study. It turned out that in the group of patients who did not eat fish, mortality from coronary heart disease was 11% higher.

The Food and Nutrition Board of the US National Academy of Sciences recommends that dietary fat intake should not exceed 30% of total calories, with less than 8% of calories coming from PUFAs. and the ratio of ω-6 to ω-3 PUFAs should be between 5:1 and 3:1.

The British Nutrition Foundation recommends that total PUFAs should account for 7.5% of total calories.

In healthy people, the inclusion of fish oil in the diet leads to an increase in the content of HDL, ω-3 PUFA in the blood plasma and phospholipids of cell membranes, and a decrease in the level of LDL and plasma triglycerides [23, 24, 25]. These changes are observed within 15 days after starting to take fish oil at a dose corresponding to 1.3 g of EPA, and are persistent. In patients with lipid metabolism disorders, the hypolipidemic effect is observed primarily in dyslipidemia types IIB and V.

Of particular importance is the hypotriglyceridemic effect of ω-3 PUFAs. Thus, daily intake of 8 capsules of fish oil (corresponding to 2.4 g of EPA and 1.6 g of DHA) reduced the level of plasma triglycerides by 38%, while the HDL content increased by 24%.

Now we can say that:

• there is a fundamental possibility of preventing and treating atherosclerosis with the help of special food supplements containing ω-3 PUFAs;
• national food programs, the purpose of which is the prevention of heart and vascular diseases in the most capable part of the population, are certainly promising.

The WHO Expert Committee considers changing the nutritional pattern of the population the main direction for the prevention of CHD (1990).

Taking ω-3 PUFAs also seems promising for secondary prevention, as well as treatment of cardiovascular diseases. In the 80s of the last century, studies by J. Mehta and co-authors (1988) were published, showing that the inclusion of ω-3 PUFAs in the diet of patients with silent myocardial ischemia led to a decrease in the number of complications in this group compared with the control (48.5 and 74.8%, respectively) and mortality (4.1 and 7%, respectively).

The GISSI-Prevenzione trial study, which included patients with a history of myocardial infarction who received 850 mg per day of ω-3 PUFA for 3.5 years, showed a reduction in coronary mortality by 30%, including sudden mortality by 45% and overall mortality by 20% [27].

According to our data, the inclusion of eikonol (a domestic food supplement containing up to 30% ω-3 PUFA) in the diet of patients with coronary artery disease at a dose of 5 g/day normalizes blood lipids, reduces hypercoagulation, has a positive effect on cerebral blood flow, and reduces the frequency and severity of ischemic episodes , has a mild hypotensive effect [28, 29].

Experts from the American Heart Association (2002) recommend:

• for patients without documented coronary artery disease, eating fish (preferably fatty) 2 times a week. You should also use oils and foods rich in α-linolenic acid (linseed oil, soybean oil, sesame seeds, walnuts);
• patients with documented coronary artery disease should consume approximately 1 g of ω-3 PUFA (total EPA + DHA) per day, mainly with fatty fish. EPA + DHA supplements should be prescribed under the supervision of a physician;
• For patients with hypertriglyceridemia, consume 2–4 g of EPA + DHA capsules per day under medical supervision.

Patients taking more than 3 g of ω-3 PUFA per day through supplements should be monitored by a physician due to the risk of bleeding.

At the same time, a number of studies have identified changes that can be classified as undesirable: increased lipid peroxidation, a decrease in the strength of bonds in LDL particles, and the development of insulin receptor resistance. Possible adverse effects of fish oil are probably due to the fact that known dietary supplements contain, in addition to ω-3 PUFAs, other fatty acids: saturated, monounsaturated, ω-6 PUFAs, which can, if not completely, then partially neutralize the positive effects of ω PUFAs -3, primarily due to an increase in the intensity of lipid peroxidation. It should be emphasized that the benefits of their use significantly outweigh the possible risks. Thus, during a long-term (25-year) observation of a large group of patients who used a diet enriched with ω-3 PUFAs, a decrease in mortality from coronary artery disease was noted in the absence of an increase in mortality from other causes [30].

A definite way out of this situation is the creation of drugs containing large doses of highly purified ω-3 PUFAs. These drugs do not contain saturated fatty acids, therefore, the amount of total fat in their composition is reduced, and low doses of vitamin E, used as an antioxidant, prevents the oxidation of PUFAs. This group includes the drugs Vitrum Cardio Omega-3 and Omacor, recently registered in Russia.

In conclusion, it should be noted that experimental and clinical studies have proven the following effects of ω-3 PUFAs in reducing cardiovascular risk:

• antiatherogenic (correction of hypertriglyceridemia, normalization of LDL and HDL levels in the blood);
• antithrombotic effect;
• decreased blood viscosity;
• anti-inflammatory effect;
• reduction of endothelial dysfunction;
• reducing the risk of arrhythmias leading to sudden death;
• moderate hypotensive effect.

Further clinical studies will evaluate the effectiveness, establish dosage regimens and the safety profile of drugs containing large doses of ω-3 PUFAs in patients with coronary artery disease and cerebrovascular diseases.

Literature

1. Simons LA Interrelation of lipids and lipoproteins with coronary artery disease mortality in 19 countries//Am. J. Cardiol. 1986; 57:5–10.
2. Vinogradov A.V., Klimov A.N., Kliorin A.I. Preventive cardiology. M., 1987.
3. Gastelli WP, Doyli JT, Gordon T.et al.//Circulation. 1977; 55: 767–772.
4. Gastelli WP Epidemiology of triglycerides: a view from Framingham. //Am. J Cardiol 1992; 70: 3–9.
5. Ross R. Atherosclerosis — an inflammatory disease//N. Engl. J. Med. 1999; 340: 115–126.
6. Meade TW, Ruddock V., Stirling Y., Chakrabarti R., Miller GJ Fibrinolytic activity, clotting factors, and long-term incidence of ischemic heart disease in the Northwick Park Heart Study//Lancet. 1993; 342:1076–1079.
7. Kannel WB Risk stratification in hypertension: new insights from the Framingham Study//Am. J. Hyhertens. 2000; 13:3–10.
8. Keys A. Seven countries: a multivariate analysis of death and coronary heart disease/Cambrige, Massachusets and London, England. 1990.
9. Heydent S., Heiss G., Bartel AG Sex differences in coronary mortality among diabetics in Evans Country, Georgia//Chronic. Dis. 1989; 33:265–273.
10. Defronzo RA Insulin resistance: the metabolic link between noninsulin-dependent diabetes mellitus, obesity, hypertension, dyslipidemia and atherosclerotic cardiovaoscular disease//Curr. Sci. 1990; 5:586–593.
11. Harris WS, Dujovne CA, Zucer M., Johnson B. Effects of low saturated fat, low cholesterol fish oil supplement in hypertriglyceridemic patients: a placebo-controlled trial//Ann. Intern. Med. 1988; 109:465–470.
12. Kromhout D., Bosschiter E.B., Coulander C. De L. The inverse relationship between fish consumption and 20-year mortality from coronary heart disease//New. Engl. J. Med. 1985; 313:1205–1209.
13. Parwaresch MR, Haacke H., Mader C. Efficacy of hypolipidemic treatment in inhibition of experimental atherosclerosis: the effect of nicotinic acid and related compounds//Atherosclerosis. 1978; 31: 395–401.
14. Siess W., Roth P., Scherer B., Kurzmann I., Bohlig B., Weber PC Platelet-membrane fatty acids, platelet aggregation, and thromboxane formation during a mackerel diet//Lancet. 1980; 1: 1(8166): 441–444.
15. Culp BR, Lands WE, Lucches BR, Pitt B., Romson J. The effect of dietary supplementation of fish oil on experimental myocardial infarction // Prostaglandins. 1980; 20 (6): 1021–1031.
16. Morris MC, Taylor JO, Stampler MJ et al. The effect of fish oil on blood pressure in mild hypertensive subjects: a randomized crossover trial// Am. J. Clin. - Nutr. 1993; 57(1):59–64.
17. Thorngren M., Gustafson A. Effect of 11-week increase in dietary eicosapentaenoic acid on bleeding time, lipids and platelet aggregation // Lancet; 1981; 11: 1190–1193.
18. Whitman SC, Fish JR, Rand ML, Rogers KA n-3 fatty acid incorporation into LDL particles renders them more susceptible to oxidation in vitro but not necessarily more atherogenic in vivo//Arterioscler Thromb. 1994; 14(7):1170–1176.
19. Hampton IR Platelets and coronary disease round three//Brit. med. J. 1985; 209:6466:414–415.
20. Kristensen SD, Schmidt EB, Andersen HR, Dyerberg Y. Fish oil in angina pectoris//Atherosclerosis. 1987; 64:13–19.
21. Haines AP, Sanders TA, Imeson JD Effects of fish oil supplement on platelet function, haetmostatic variables and albuminuria in insulin-dependent diabetics//Thromb. Res. 1986; 43:643–655.
22. Aukema HM, Holub BJ Effect of dietary supplementation with a fish oil concentrate on the alkenylacyl class of ethanolamine phospholipid in human platelets//J. Lipid. Res. 1989; 3:59–64.
23. Mueller BA, Talbert RL Biological mechanisms and cardiovascular effects of omega-3 fatty acids//Clin. Pharmacol. 1988; 7: 795–807.
24. Sanders TAB, Hochland MC A comparison of the influence on plasma lipids and platelet function of supplements of omega 3 and omega 6 polyunsaturated fatty acids//Brit. J. Nutr. 1983; 50:521–529.
25. Cullen P. Evidence that triglycerides are an independent coronary heart disease risk factor//Am. J. Cardiol. 2000; 86:1:943–949.
26. Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI — Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell`Infarto miocardico//Lancet. 1999; 354:447–455.
27. Lee E. D., Isaev V. A., Prokhorovich E. A. et al. New antiatherogenic components of the diet // Clinical pharmacology and therapy. 1994. No. 3. pp. 23–36.
28. Martynov A. I., Martynov I. V., Prokhorovich E. A. et al. Results of using the dietary supplement “eikonol” in patients with coronary heart disease // Clinical Bulletin of the PMC. 1994. No. 2.>
29. Shekelle RB, Missell LV, Paul O. et al. Fish consumption and mortality from coronary heart disease//N. Engl. J. Med. 1985; 312:820–824.

E. A. Prokhorovich, Doctor of Medical Sciences, Professor N. N. Vladimirova MGMSU, Moscow

Benefit or harm

In this case, the question arises: where did this myth come from that Omega-3 fatty acids help in the fight against atherosclerosis? Most likely, from the fact that cholesterol is much more difficult to make from unsaturated fats. Therefore, many patients believe that if they consume little saturated fat, the body will produce less cholesterol, and therefore the blood vessels will be healthy. This does not take into account the fact that during the metabolism of unsaturated fats, metabolites appear that have a very detrimental effect on humans, and in their harmfulness can exceed the “mythical” harm of cholesterol.

Thus, from a scientific point of view, Omega-3 fatty acids, like other unsaturated fats, do not bring any benefit in the fight against atherosclerosis. If you use them as medicine, this does not affect the organs and systems in any way. The fact is that a huge number of different acids take part in metabolism. Medicines contain microscopic doses of fatty acids, so they do not have any effect, and there is no point in overpaying for expensive medicines.

Roughly speaking, vegetable fats can be much more harmful to the human body than high-quality animal fats. Good animal fats have a beneficial effect on the digestive system, saturate the blood with useful substances, are easily digestible and restore cholesterol metabolism.

Advice:

The highest quality and healthy fats are found in dairy products (cheese, butter, sour cream, full-fat milk).

Vegetable fats, such as olive oil, are more difficult for the body to process and absorb than animal fats. Especially when it comes to buying “miraculous” capsules with Omega-3. This indicates ignorance of the biochemical processes in the human body, so it is worth becoming more familiar with the scientific side of the issue before strictly following all the instructions of the doctor who prescribes these pills.

Alternatives to statins

Some patients cannot tolerate statins and need an alternative. Doctors may suggest a combination of dietary changes and lipid-lowering medications, such as:

• ezetimibe
• fibrates
• a nicotinic acid
• bile acid sequestrants
• proprotein convertase subtilisin/kexin inhibitors type 9

Each of these drugs has different effects, and not all of them are direct replacements for statins. Some patients may need to take more than one lipid-lowering drug to control their cholesterol levels.

The diet may also help those who are intolerant to statins. Doctors may recommend a diet that:

• has low saturated fat content
• rich in fiber
• contains plant sterols, which people can get from fruits, vegetables, seeds and nuts

Chinese red yeast rice may be an additional option for some people. This dietary supplement produces substances that also inhibit the enzyme HMG-CoA reductase, a target of statin drugs.

However, statins have great cholesterol-lowering potential, and as a supplement, Chinese red yeast rice can vary in strength and quality, much like fish oil supplements. In addition, some products may contain harmful contaminants. Because of this, it is important to talk to your doctor before using Chinese red yeast rice for any health condition.