What if one of the most common “heart healthy” supplements is mostly giving people reassurance, not protection?

That is the uncomfortable question I had to ask myself about fish oil, which I took daily (even though I hate fish!).

I also walk through this step-by-step here (video):

For years, I took over-the-counter omega-3 capsules because I thought they were protecting my heart. It seemed reasonable. Omega-3s sounded biologically plausible. Fish intake has long been associated with better cardiovascular health. The bottles were everywhere. The marketing was confident. And compared with prescription medications, fish oil felt safe, natural, and harmless.

But medicine has a way of humbling us. A good story is not the same thing as a good trial.

When researchers have tested ordinary over-the-counter fish oil supplements, especially the common EPA plus DHA combinations, the results have generally not shown what many people assume. These supplements have not reliably reduced heart attacks, strokes, or cardiovascular death in broad populations. The American College of Cardiology has summarized this point plainly: routine use of non-prescription fish oil is not recommended for primary or secondary prevention of cardiovascular disease. (American College of Cardiology)

That does not mean omega-3 biology is useless. It means the details matter.

EPA and DHA are not interchangeable. Dose matters. Purity matters. The patient population matters. Whether someone has established cardiovascular disease matters. Whether triglycerides remain elevated despite statin therapy matters. And the distinction between a supplement bottle from a retail shelf and a prescription medication studied in thousands of high-risk patients matters.

The most important example is icosapent ethyl, a purified prescription form of EPA. In the REDUCE-IT trial, high-risk patients taking statins who received icosapent ethyl had fewer major cardiovascular events than those taking placebo. This is the finding behind much of the excitement about prescription EPA. It is not the same as saying that ordinary fish oil capsules prevent heart attacks. It is a much narrower, more clinically specific claim. (American College of Cardiology)

There is also a safety side. Higher-dose omega-3 treatment has been linked to a higher risk of atrial fibrillation, a heart rhythm problem that can increase stroke risk and often requires ongoing medical management. The risk is not enormous in absolute terms, but it is real enough that it should be part of the discussion, especially for people with a history of arrhythmias or those taking blood thinners. (Cedars-Sinai)

So the better question is not, “Is fish oil good or bad?”

The better question is: Which omega-3, at what dose, for which person, and for what outcome?

That is less catchy than the label on a supplement bottle. But it is much closer to how careful medicine works.

A Clinical Pearl People Often Miss

A patient once told me, “I’m already taking fish oil, so I think I’m doing something for my heart.”

That sentence captures a common problem. People often treat supplements as if they are softer versions of prescription medications. But in cardiovascular prevention, that assumption can mislead.

The clinical pearl is this: do not mentally group all omega-3 products together.

Eating fatty fish, taking an over-the-counter EPA/DHA supplement, taking high-dose prescription omega-3 for triglycerides, and taking purified prescription EPA for cardiovascular risk reduction are not the same intervention.

• For most generally healthy people, the most defensible “omega-3 strategy” is still food first: eat fish if you can, especially oily fish such as salmon, sardines, or mackerel.

• For people at higher cardiovascular risk, especially those with established cardiovascular disease or diabetes plus other risk factors, prescription EPA may be worth discussing with a physician. But that is a medical decision, not a supplement aisle decision.

The subtle mistake is thinking the word “omega-3” tells you enough. It does not.

Three Worthwhile Reads

1. “AstraZeneca’s Blood Pressure Drug Wins U.S. Approval”

This recent story covers the FDA approval of baxdrostat, a new aldosterone-targeting medication for patients with uncontrolled high blood pressure despite existing treatment. I include it because hypertension remains one of the most important drivers of cardiovascular risk, and new approaches to difficult-to-control blood pressure may matter for many patients over time. (Reuters)

2. “US Health Secretary Kennedy Fires Heads of Key Preventive Health Panel”

This is not a supplement story, but it is highly relevant to patients. The U.S. Preventive Services Task Force influences which preventive services are recommended and often covered without cost-sharing. Any disruption to that process deserves public attention because prevention guidelines affect cancer screening, heart disease prevention, and many everyday clinical decisions. (Reuters)

3. “US Cancer Clinics Scramble to Get Experimental Revolution Medicines Pancreatic Cancer Drug”

This article describes early access efforts for an experimental pancreatic cancer drug, daraxonrasib, after promising survival data. It is worth reading because it shows the tension between hope, evidence, access, and urgency in serious illness. For patients and families, these stories are emotionally powerful, but they also require careful interpretation. (Reuters)

One Final Thought

One of the hardest things in health is learning when a simple story has become too simple.

“Fish oil is good for your heart” is simple. It is also incomplete.

The more accurate story is less convenient but more useful: real food is different from supplements, EPA is different from DHA, prescription products are different from retail bottles, and a result in high-risk patients does not automatically apply to everyone.

That kind of nuance can feel frustrating. But it is also where better decisions begin.

Thank you for reading. If you know someone who takes fish oil for heart health, or someone trying to make sense of supplements and cardiovascular prevention, feel free to pass this along. These are exactly the kinds of questions that are easy to oversimplify and worth slowing down to understand.

To your health,
-Dr. Haque

—

This newsletter is for educational and informational purposes only and should not be considered personal medical advice. Always consult your physician or a qualified healthcare professional before making changes to your medications, diet, supplements, exercise, or health routine. Reading this content does not create a physician–patient relationship with Dr. Haque.

When is it good to accept suffering?

Accept? What?!?

That question sounds strange in a medical culture built, understandably, around relief. We want to reduce pain, treat disease, shorten recovery, and help people feel better. That is good work.

But the deeper question is not whether suffering is good in itself. Usually it is not. The better question is whether trying to avoid every form of suffering can quietly make us less honest, less resilient, and less able to love well.

Some suffering is needless and should be opposed. The suffering of untreated depression. The suffering of preventable disease. The suffering that comes from abuse, neglect, addiction, or medical error. We should not romanticize any of that.

But other forms of suffering seem woven into the structure of a meaningful life. There is the soreness of rehabilitation after surgery. The frustration of weight loss that makes it sustainable long term. The grief that comes with loving aging parents. The anxiety of waiting for an important biopsy result that signals the value of the result. The loneliness that can come with telling the truth when it costs you something. There is no mature life that avoids all of this.

Acceptance, in that sense, is not passive. It is not the same as giving up. It is closer to reality-based courage. It means recognizing that some discomfort is not a sign that something has gone wrong. Sometimes it is the price of healing. Sometimes it is the cost of love, meaning, and self-overcoming. Sometimes it is simply what it feels like to live truthfully in a fragile body in a finite world (Haque et al., 2026).

The art, both in medicine and in life, is learning to tell the difference between suffering that should be relieved and suffering that should be endured with patience, wisdom, and support.

A Clinical Pearl People Often Miss

A 56-year-old man once told me, with understandable satisfaction, that he had “fixed” his cholesterol. He had improved his diet, lost a little weight, and his latest LDL number looked better than it had the year before. What he had not really considered was time.

One of the most important things people miss about cholesterol is that risk is cumulative. Atherosclerosis does not care only about today’s LDL. It also reflects years of exposure. That is one reason modern lipid guidance emphasizes earlier and more sustained LDL lowering in people at meaningful risk. A better number this year is good news, but it does not fully erase the biological effects of a high number over the previous decade (Ference et al., 2017).

That does not mean every patient needs aggressive medication. It does mean cholesterol management is best understood as long-term risk reduction, not as a single lab result passed or failed.

Three Worthwhile Reads

How the Whole-Grain Trend Went Wrong by Trisha Pasricha.
Many whole-grain foods behave in the body much the same as the refined products they were meant to replace! A thoughtful corrective to simplistic nutrition labeling. The most useful point is not that whole grains are bad. It is that heavily processed “whole-grain” foods may not behave metabolically like the healthier foods many consumers imagine they are buying. (The Atlantic)

Lilly’s Weight-Loss Pill Wins U.S. Approval, Sets Up Next Battle With Rival Novo Nordisk by Leah Douglas and Christy Santhosh.
Worth reading because oral GLP-1 drugs may change the obesity conversation again, especially for patients who care as much about convenience and adherence as efficacy. Reuters reports that Lilly’s newly approved pill helped trial participants lose about 12% to 15% of body weight. (Reuters)

A Cancer Treatment That Does More Than Scientists Thought
Originally designed for cancer, CAR-T is now raising cautious hopes in some autoimmune diseases too. This piece is worth reading because it captures both the excitement and the restraint that frontier medicine requires when early promise begins to spill into entirely new areas of care. Published April 9, 2026. (The Atlantic)

One Final Thought

One mark of maturity is learning not to ask only, “How do I make this feeling go away?” Sometimes that is exactly the right question. But sometimes the better question is, “What is this burden asking of me?” More patience? Better judgment? More courage? More support? In health, as in the rest of life, wisdom often begins there.

Thank you for reading. This week’s theme is really about discernment: knowing which burdens should be treated, which risks should be reduced early, and which hard things are simply part of loving and living honestly.

If you know someone who might find this helpful, feel free to pass it along. Paid members are welcome to share questions or thoughts in the comments.

To your health,
-Dr. Haque

PS:

For a clear, evidence-based look at Zetia and statin intolerance, watch my new video here:

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References

Ference, B. A., Ginsberg, H. N., Graham, I., Ray, K. K., Packard, C. J., Bruckert, E., ... & Catapano, A. L. (2017). Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. European heart journal, 38(32), 2459-2472.

Haque, O. S., Wortham, J., Case, B. W., Cowden, R. G., Goodman, D., Lomas, T., ... & Vander Weele, T. J. (2026). Acceptance as a Response to Suffering: Insights from World Religious and Philosophical Traditions. Journal of Religion and Health, 1-25.

This newsletter is for educational and informational purposes only and should not be considered personal medical advice. Always consult your physician or a qualified healthcare professional before making changes to your medications, diet, supplements, exercise, or health routine. Reading this content does not create a physician–patient relationship with Dr. Haque.

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