Written by
Louise W Lu, PhD, MPH, BMLS
Written/Reviewed by
Alexandra V Goldberg, Registered Dietitian
Click to enlarge
Click to enlarge
“The LDL that rises with DHA isn’t always the ‘bad kind’. The key is what form that LDL takes.”
This article will use the above Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association as a starting point and break down three key questions you care about most:
1) Why do some people see their LDL number go up after taking DHA?
2) Is that rise the same as a rise in truly “dangerous” LDL?
3) When choosing EPA, DHA, or a combination, how can you avoid the pitfalls and actually feel more confident?
1) Why do some people see their LDL number go up after taking DHA?
2) Is that rise the same as a rise in truly “dangerous” LDL?
3) When choosing EPA, DHA, or a combination, how can you avoid the pitfalls and actually feel more confident?
Quick Navigation:
Does DHA Raise LDL? What Does the Evidence Really Say?
You often see this claim online: “EPA lowers triglycerides without raising LDL; DHA also lowers triglycerides, but it may increase LDL.” It sounds scary, but it’s not the full story. Let’s use the American Heart Association’s official report as a starting point to clarify the facts.
“What DHA really does is speed up the clearance of very-low-density lipoproteins (VLDL), so on a blood test it can look like LDL has gone up.”
Let’s first make two terms clear:
Very-Low-Density Lipoprotein (VLDL): Produced by the liver, its main job is to transport triglycerides and some cholesterol—think of it as a “big truck” loaded with fat cargo.
As it delivers triglycerides along the way, the truck shrinks, the triglyceride content drops, the proportion of cholesterol rises, and it gradually transforms into Low-Density Lipoprotein (LDL).
Low-Density Lipoprotein (LDL): Often called “bad cholesterol.” Its main task is to carry cholesterol, but not all LDL particles are equally harmful:
- Small, dense LDL are like mini-trucks that can easily squeeze into artery walls, fueling plaque buildup.
- Larger, fluffier LDL are bulkier and less likely to get stuck in blood vessels.
In short: VLDL is the “precursor” of LDL—once it unloads triglycerides, it remodels into a cholesterol-focused transport truck.
Very-Low-Density Lipoprotein (VLDL): Produced by the liver, its main job is to transport triglycerides and some cholesterol—think of it as a “big truck” loaded with fat cargo.
As it delivers triglycerides along the way, the truck shrinks, the triglyceride content drops, the proportion of cholesterol rises, and it gradually transforms into Low-Density Lipoprotein (LDL).
Low-Density Lipoprotein (LDL): Often called “bad cholesterol.” Its main task is to carry cholesterol, but not all LDL particles are equally harmful:
- Small, dense LDL are like mini-trucks that can easily squeeze into artery walls, fueling plaque buildup.
- Larger, fluffier LDL are bulkier and less likely to get stuck in blood vessels.
In short: VLDL is the “precursor” of LDL—once it unloads triglycerides, it remodels into a cholesterol-focused transport truck.
Click to enlarge
- When DHA intake is ≥ 1 g/day, an increase in LDL levels may be observed.
- DHA speeds up the clearance of “fat trucks” (VLDL) in the bloodstream. Some VLDL are eventually converted into LDL, which can make blood test numbers appear higher. But these LDL particles are usually larger and fluffier, less sticky to artery walls compared to small dense LDL.
- EPA mainly lowers triglycerides and generally has little effect on LDL because it doesn’t significantly accelerate VLDL clearance—so fewer VLDL are converted into LDL.
- Clinical studies (e.g., Bays HE, 2020; Mozaffarian D, 2006) consistently show that DHA lowers triglycerides, raises good cholesterol (HDL), but sometimes with a modest LDL increase.
| Parameter | EPA (Eicosapentaenoic acid) | DHA (Docosahexaenoic acid) | Clinical Meaning |
|---|---|---|---|
| Triglycerides (TG) | Significantly reduced (potent blood triglyceride lowering) | Significantly reduced (similar or slightly weaker than EPA) | Both are clearly beneficial for high-TG individuals |
| Good cholesterol (HDL) | Modest or mild increase | Stronger increase | DHA has an advantage for raising HDL |
| Bad cholesterol (LDL) | Neutral or slight decrease overall | Small increase in some people (≈ 5–10%) | DHA-related rise is mostly in larger LDL particles, not the risky small dense type |
| LDL particle size | No major change | Increases (larger, lighter particles) | Larger particle size may reduce artery risk |
| Overall artery risk | Evidence suggests plaque-stabilizing benefits | Shifts lipid profile in a more “favorable” direction | Look at structure and size, not just the LDL number |
“An increase in LDL numbers doesn’t necessarily mean higher risk. The key is LDL particle ‘size and shape’—DHA often makes them larger and less sticky to artery walls.”
Summary: DHA may cause a modest rise in LDL in some people or at higher doses; however, its typical effects—lower triglycerides, higher HDL, and larger LDL particles—mean that overall cardiovascular risk may not actually increase.
Who Should Be More Careful with DHA?
While DHA offers real benefits—lowering triglycerides and improving HDL—it can still raise LDL in some people. If your LDL is already high or you have elevated cardiovascular risk, be cautious with DHA and avoid high-dose DHA when necessary. When using fish oil, consider focusing more on EPA and recheck your lipid panel regularly.
Bottom line first: If you fall into any of the groups below, use DHA with dose and lab monitoring in mind. Prefer a plan that is EPA‑forward with DHA as support, and repeat your lipid tests in 4–8 weeks.
-
LDL already elevated / High ASCVD risk
You need tighter control of every LDL fluctuation. DHA can cause a small bump in numbers; start with a high‑EPA formula and track LDL‑C / non‑HDL‑C / ApoB.
-
Predominantly small‑dense LDL, high ApoB or non‑HDL‑C
Your risk is more about particle number and size. If using DHA, start low‑dose, then adjust only if particle size/ApoB improves.
-
Metabolic syndrome / Insulin resistance / Fatty liver / Type 2 diabetes
VLDL production/processing is more active; the VLDL → LDL shift is easier to see. Prefer an EPA‑led approach to lower TG, with small DHA add‑on.
-
Men (middle‑aged/older) or APOE‑ε4 carriers
More likely to show a modest LDL rise on labs; begin with EPA:DHA ≥ 2:1 and fine‑tune after retesting.
-
Planning high‑dose DHA (≥ 1 g/day) or high‑DHA blends
The rise is easier to detect; if the goal is to lower TG first, choose high EPA with low‑to‑moderate DHA.
-
Reduced LDL clearance (e.g., hypothyroidism, CKD, post‑menopause)
You may be more sensitive to LDL changes; prefer EPA first, test small DHA doses cautiously, and pair with lifestyle changes (weight, glucose, soluble fiber).
“If your goal is to bring triglycerides down first and then optimize cholesterol quality, leading with EPA is safer. Use DHA as a low‑to‑moderate ‘structure optimizer’—and adjust based on your lab results.”
| Scenario | Starting approach | Retest & adjust |
|---|---|---|
| High TG, normal/slightly high LDL | EPA‑forward (EPA:DHA ≥ 2:1), small‑dose DHA | Retest in 4–8 weeks: TG, LDL‑C, non‑HDL‑C, ApoB. If LDL ↑ ≥10%, cut DHA or raise EPA ratio. |
| LDL already high / High ASCVD risk | Prioritize high‑EPA formula; delay or limit DHA | Focus on LDL‑C & ApoB; use EPA‑only if needed |
| Small‑dense LDL predominant / High ApoB | Test low‑dose DHA + EPA‑led plan | Adjust DHA only if LDL size/non‑HDL‑C/ApoB improve |
| Metabolic syndrome / Fatty liver | EPA‑led to control TG & liver fat; add low DHA | Pair with weight, glucose, fiber, exercise; tune DHA per LDL response |
Practical plan (easy to follow):
1) Short‑term strategy: Start with Saintstar EPA1000 or NYO3 97% High‑EPA Fish Oil (EPA ≥97%) to quickly lower LDL and TG.
2) Long‑term strategy: Transition to an EPA content around 70%, e.g., PNZ1440 EPA to maintain LDL while optimizing the overall profile.
3) Retest window: Recheck LDL‑C, non‑HDL‑C, ApoB, TG in 4–8 weeks; if LDL or ApoB rise notably (e.g., ≥10%), reduce DHA, increase EPA ratio, or use EPA‑only.
4) Lifestyle pairing: Cut refined carbs and trans fats; add soluble fiber (oats, legumes, inulin); keep exercise and weight management on track.
1) Short‑term strategy: Start with Saintstar EPA1000 or NYO3 97% High‑EPA Fish Oil (EPA ≥97%) to quickly lower LDL and TG.
2) Long‑term strategy: Transition to an EPA content around 70%, e.g., PNZ1440 EPA to maintain LDL while optimizing the overall profile.
3) Retest window: Recheck LDL‑C, non‑HDL‑C, ApoB, TG in 4–8 weeks; if LDL or ApoB rise notably (e.g., ≥10%), reduce DHA, increase EPA ratio, or use EPA‑only.
4) Lifestyle pairing: Cut refined carbs and trans fats; add soluble fiber (oats, legumes, inulin); keep exercise and weight management on track.
