Should I Take Fish Oil if I Have High Cholesterol?


Having elevated cholesterol levels raises your risk for heart disease. This makes optimizing your cholesterol profile crucial for heart health.

Fish oil is rich in omega-3 fatty acids that provide numerous benefits for cardiovascular wellness. This has many wondering if fish oil can also help improve high cholesterol.

Below is a detailed look at the evidence on using fish oil supplements if you have elevated cholesterol or hyperlipidemia.

Should I Take Fish Oil if I Have High Cholesterol?

An Overview of High Cholesterol

Cholesterol is a waxy, fat-like substance found in your bloodstream. Your body needs it to build healthy cells, but having high levels can lead to atherosclerosis and heart attacks.

The two main types are:

  • LDL cholesterol: Called “bad” cholesterol. Excess LDL causes plaque buildup in arteries.
  • HDL cholesterol: Called “good” cholesterol. HDL removes LDL from blood vessels and protects heart health.

Doctors assess cholesterol levels by looking at:

  • Total cholesterol level
  • LDL and HDL amounts
  • Triglycerides (blood fats)
  • Ratio of total cholesterol to HDL

High total cholesterol, elevated LDL, low HDL, and high triglycerides all increase heart disease risk.

Lifestyle and medication are first-line treatments for improving cholesterol levels. But could adding fish oil also help? Let’s take a closer look.

How Might Fish Oil Benefit High Cholesterol?

Fish oil provides EPA and DHA omega-3 fatty acids that influence aspects of cholesterol and triglyceride metabolism. Potential benefits include:

Raises HDL cholesterol - Fish oil moderately increases HDL, with greater effects at higher doses. Even a small uptick in HDL helps lower heart disease risk.

Makes LDL particles larger - Fish oil helps convert small, dense LDL into larger, fluffier particles that are less damaging to arteries.

Improves cholesterol ratio - By boosting HDL, fish oil improves your total cholesterol to HDL ratio. A lower ratio protects heart health.

Lowers triglycerides - Fish oil excel at lowering elevated triglyceride levels by 20-30%, which also protects arteries.

Reduces oxidation and inflammation - Omega-3s hinder oxidation of LDL cholesterol and inflammation - two key drivers of atherosclerosis development.

So while fish oil may not drastically lower total or LDL cholesterol, it provides several other benefits to enhance your cholesterol profile.

Next, let’s analyze what the clinical research says about fish oil for high cholesterol.

Does Research Show Fish Oil Improves High Cholesterol?

Numerous studies have been conducted analyzing the effects of fish oil supplements on cholesterol levels. Here’s an overview of findings:

Total and LDL Cholesterol

  • Meta-analyses show no significant reduction in total or LDL cholesterol with fish oil.
  • Some studies found a small decrease of 7-10 mg/dL total cholesterol after 3-4 months use. But effects are minor.
  • Fish oil does not appear effective for substantially lowering total or LDL cholesterol.

HDL Cholesterol

  • Most studies demonstrate fish oil increases HDL levels, especially at higher doses.
  • Increases average around 3-7% over a 6-12 week period.
  • Doses of 3-4 grams EPA/DHA per day have the greatest HDL boosting effect.


  • Many studies confirm fish oil significantly lowers triglycerides, usually by 20-30%.
  • 1-2 grams EPA/DHA per day is effective for reducing elevated triglycerides.
  • Greatest triglyceride lowering effect is in those with very high pre-treatment levels.

Cholesterol Ratio

  • By raising HDL, fish oil also improves cholesterol ratios like total cholesterol/HDL.
  • Improving this ratio lowers heart disease risk even if total cholesterol stays the same.

So while fish oil should not be viewed as a solution for drastically slashing LDL or total cholesterol, research confirms it provides several other lipid optimizing effects.

What Type of Fish Oil is Best for High Cholesterol?

For maximizing fish oil’s cholesterol benefits, choose a supplement that provides:

  • Higher doses of 2-4 grams total EPA/DHA daily
  • At least 60% of omega-3s from EPA
  • High purity oils free from contaminants
  • Triglyceride form for optimal absorption

A pure, high-EPA fish oil taken at an adequate dosage provides the greatest improvements in HDL, triglycerides, and cholesterol ratios.

Always look for third party testing showing the product is free of heavy metals, PCBs, dioxins and other contaminants.

How Should Fish Oil be Taken to Improve Cholesterol?

Follow these tips to use fish oil effectively for cholesterol support:

  • Take 2-4 grams daily of combined EPA/DHA
  • Split dose into 2-3 servings throughout the day
  • Always take with food to increase absorption
  • Give it at least 3-4 months for maximal benefits
  • Have cholesterol retested after 6 months to assess impact
  • Combine with exercise and a heart-healthy, Mediterranean style diet

Taking a pharmaceutical-grade fish oil supplement as recommended provides the best odds of optimizing your cholesterol profile. But remember lifestyle remains crucial too.

Are there Risks or Concerns With Using Fish Oil for High Cholesterol?

Provided purity is verified, fish oil is very safe for long-term daily use based on extensive research.

Potential minor side effects may include:

  • Fishy aftertaste
  • Gastrointestinal upset
  • Loose stools

Starting with a lower dose and taking with meals can minimize stomach discomfort. Enteric coated fish oil may reduce fishy burps.

At excessively high intakes, fish oil could theoretically increase LDL cholesterol by downregulating hepatic LDL receptors. But this is not seen at amounts under 5 grams per day.

Those on blood thinners should have their clotting time monitored and medication adjusted if needed. Otherwise, fish oil is very safe for improving cholesterol.

Other Natural Methods That May Help Lower High Cholesterol

While fish oil should be part of your routine, several other natural approaches may also benefit hyperlipidemia:

Soluble fiber - 10-25 grams daily shown to reduce LDL cholesterol. Get soluble fiber from oats, nuts, seeds, beans, fruits and vegetables.

Soy protein - 25 grams per day shown to lower LDL. Try soy milk, tofu, tempeh and edamame.

Garlic - May reduce total and LDL cholesterol by up to 15% when eaten regularly.

Niacin - Vitamin B3 shown to raises HDL. Must be monitored by a doctor for safety.

Polycosanol - Sugar cane extract may lower LDL by 10-15%.

Plant sterols - Found in vegetable oils, nuts and seeds. Shown to reduce LDL absorption in the gut by 10-15%.

Coenzyme Q10 - Shown to lower oxidized LDL particles. Typical dose is 100-200 mg per day.

Adopting a heart healthy diet and lifestyle remains the foundation. But adding fish oil and other natural strategies can provide further cholesterol optimizing benefits.

Should I Take Fish Oil for High Cholesterol? The Bottom Line

In summary, clinical evidence suggests fish oil supplements can provide significant value if you have elevated cholesterol or triglyceride levels.

While effects on lowering total or LDL cholesterol are minor, fish oil provides several other lipid-optimizing effects:

  • Raises HDL
  • Lowers triglycerides
  • Improves cholesterol ratios
  • Converts LDL to larger, less damaging particles
  • Reduces oxidation and inflammation

For best results, choose a quality high-EPA fish oil providing 2-4 grams combined EPA/DHA daily. And give it at least 3-6 months to work.

Fish oil is not a magic cure-all for high cholesterol on its own. But paired with heart-healthy lifestyle changes, it can help keep your cholesterol profile optimal for heart health.

So if you have elevated cholesterol, adding a pharmaceutical-grade fish oil supplement is recommended after discussing with your doctor. Keeping your cholesterol in check is too important for heart health.

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