if a disaster knocks you off the grid for long enough, the medicines eventually run out no matter how well you’ve prepared. This is especially true for drugs which you can only stockpile in limited quantities, simply because they’re too expensive. One item that isn’t too expensive is fish oil, commonly available in supplements or in FDA-approved prescription items. The scientific data shows that they can reduce triglycerides in your blood, a factor in coronary artery disease, and perhaps help in other ways.

First, what is fish oil? Fish oil is the fat or oil that’s extracted from fish tissue. Squeeze a fish, get some oil. Most of it comes from “oily” fish, such as herring, tuna, anchovies, salmon, and mackerel. It’s sometimes produced from the livers of other fish, an example being the time-honored cod liver oil.

The World Health Organization (WHO) doesn’t recommend fish oil supplements, but it does recommend eating 1–2 portions of fish per week. This is because the omega-3 fatty acids in fish are thought to provide many health benefits, including a level of protection against a number of diseases. The FDA has approved fish oil products like Lovaza and Vascepa as a good way to fight high triglycerides and total cholesterol levels, especially in those who don’t incorporate fish in their diet.

Back to that in a minute. It’s been a long time since I’ve talked about triglycerides and cholesterol, so let’s take a moment to discuss them…

We’ve all heard about bad cholesterol, but cholesterol is made by all animal cells and is an essential structural component of cell membranes. It is also a prerequisite for all steroid hormones, bile, and even vitamin D. That means you can’t produce them without cholesterol as a building block. Cholesterol was first discovered in gallstones in the 18th century, we called it “cholesterine” then.

In vertebrates, liver cells typically make the greatest amounts. It’s absent in almost all prokaryotes, you might ask what’s a prokaryote? Well, if you’ve got a copy of our book Alton’s Antibiotics and Infectious Disease, you know that I’m talking about bacteria and even earlier organisms like archaea, so I guess you can say that bacteria are immune to heart disease (mostly because they don’t have hearts, haha, a little microbiology humor there).…nothing? I guess you have to be a microbiologist…

Anyway, The latest FDA-approved fish oils like Lovaza and Vascepa, are mostly about triglycerides. Triglycerides are a type of fat found in your blood. When you eat, your body converts calories it doesn’t need to use right away into triglycerides. The triglycerides are stored in your fat cells to be released later to get energy between meals.

So since we need cholesterol and triglycerides to live, what’s the problem?

If your diet is full of bad fats and carbohydrates and you eat a lot more calories than you burn, you may have high triglycerides. If your triglyceride level is too high, it may lead to thickening of the artery walls from the formation of plaques (also known as atheroscleroisis). This increases the risk of stroke, heart attack and heart disease. Extremely high triglycerides can also cause an inflamed pancreas, also known as (pancreatitis).

LDL stands for low density lipoprotein and it’s what known as “bad” cholesterol. This is because having high levels of it can lead to plaque buildup in your arteries and result in heart disease and stroke. HDL (high density lipoprotein) or good cholesterol absorbs bad cholesterol and carries it back to the liver, which flushes it from the body.

LOWERING TRIGLYCERIDES AND CHOLESTEROL

So what are some ways to lower triglycerides and cholesterol?

Let’s start with lifestyle changes:

Choose healthier fats. Avoid trans fats or foods with hydrogenated oils. Trade saturated fat found in meats for healthier fat found in plants, such as olive and canola oils. Instead of red meat, try fish high in omega-3 fatty acids — such as salmon. I prefer the actual fish to fish oil supplements. Supplements are most useful if you have a proven deficiency or just can’t get to a natural source of the nutrient in the supplement.

Other things you can do:

Exercise regularly. Aim for at least 30 minutes of physical activity on frequently during the week. Regular exercise can lower triglycerides and boost your “good” cholesterol.

Avoid sugar and refined carbohydrates. These can increase triglycerides. In excess, they are, in fact, poison.

Lose weight. If you have triglyceride issues, Cut some calories so that less are converted to triglycerides and stored as fat.

Limit how much alcohol you drink. Alcohol is high in sugar and calories and has a significant effect on triglycerides.

If lifestyle changes aren’t enough, see a doctor before the you-know-what hits the fan. Your doctor might suggest medications like:

Statins or Fibrates. These prescription drugs lower triglycerides and cholesterol, especially in those with diabetes or a history of blocked arteries. A well-known example of a statin is atorvastatin (Lipitor). A fibrate might be something like fenofibrate: Tricor. These drugs, however, can negatively affect your liver, kidney or have other effects, though, so regular monitoring by a professional would be appropriate.

Niacin is over the counter and may help. Niacin can lower your triglycerides and (LDL) the “bad” cholesterol. The problem is that niacin can cause significant side effects.  One particularly strange one happened to a friend of mine, he called me one day to say that he turned red and had itching all over. I went to see him, and sure enough, he was beet red, flushed, and very uncomfortable, it took hours for it to go away. Everyone’s a little bit different, but if this happens to you, skip the niacin or at least lower the amount you take.

I started this article talking about fish oil: Is it useful for triglycerides and cholesterol?

Regarding Vascepa, the latest fish oil approved by the FDA, some studies have shown to the FDA’s satisfaction that VASCEPA can lower very high triglycerides without raising bad cholesterol (LDL-C). Other fish oils and even the prescription fish oil supplement Lovaza do that too, but Vascepa differs in that it doesn’t contain something called DHA, a substance that has some good effects but is also known to raise bad cholesterol. Lovaza, and non-prescription fish oil supplements that lower triglycerides do contain DHA, docosahexaenoic acid, that’s a tongue twister, and could raise bad cholesterol. Vascepa theoretically eliminates that dilemma,

Although Vascepa lowers your total cholesterol and tryglcerides, It is not known whether Vascepa will really lower your risk of developing heart disease or stroke . These studies usually take many years of follow-up to see if those who use Vascepa or Lovaza live longer and have less heart attacks and strokes than the general population. That’s not been proven so far. Also, this stuff ain’t cheap, although the Vascepa website has coupons you can use. What’s more, too much fish oil can impair your blood’s ability to clot. Don’t take more than 3 g daily.

One thing you should know about fish oil is that it can oxidize and lose its beneficial effects if stored poorly. Light, oxygen exposure, and heat can all contribute to oxidation of fish oil. Keeping it cold and dark in a refrigerator can help keep fish oil’s benefits intact longer, although it doesn’t keep more than a few months after expiration.

Note: If your expired fish oil supplements smell bad or appear slightly discolored, don’t take them. Taking rancid, expired fish oil supplements can cause gastro-intestinal side effects and cause you to feel ill.

You should also be aware that fish oil can contain mercury, especially from imported fish from the ocean. Unless you’re a glass thermometer, mercury isn’t good for you; its existence is supposed to be made public by the manufacturer. To be in compliance with U.S. requirements, the amount of mercury is required to be within safe levels, but is it?? With Vascepa and Lovaza, which are produced under strict supervision and held at a higher standard than non-prescription brands, it probably is.

In any case, if you have bad cholesterol and high triglycerides, consider making dietary changes like eating less fats and carbohydrates and more protein, like fish. Also, get your sugar, BP, and other issues under control.

Bottom line about fish oil in survival scenarios? Instead of squeezing fish to get oil, you’re probably a lot better off just cooking and eating them. Believe me, you could do worse than incorporating fish into your diet. By the way, you can also get your omega-3s from other natural sources, especially ground flaxseed or flaxseed oil. Alternate sources of omega-3s also include chia seeds, walnuts, canola oil, pumpkin seeds, and soy oil. If you’re off the grid, though, and can’t access any other source of omega-3s, fish oil supplements might be useful if you could store them appropriately.

Joe Alton MD