No one knows how the health care debate will end but one inarguable fact is we all need to stay as healthy as possible. Exercise and nutritious eating are a given, but what about adding supplements? Since heart disease is the leading cause of death for men and women, that seems a good place to begin the discussion.

Fish oil has long been recommended for people with heart disease and high triglycerides. Numerous studies have shown that moderate consumption of fish oil containing the potent omega-3 fatty acids DHA and EPA decreases the risk of major cardiovascular events such as sudden cardiac death, coronary heart disease and death in patients with heart failure.

Naturally good sources are fatty fish such as mackerel, herring sardines and salmon. A three-ounce portion of wild salmon has 1,840 mg of DHA and EPA, canned white tuna has 862 mg and sardines have 838 mg. Cooked tilapia, the most commonly eaten fish, has only 221 mg. The American Heart Association recommends that people with heart disease get at least 1,000 mg a day. So if you have heart disease, assess your fish intake and talk to your doctor before starting a supplement.

A review article from this month's Journal of the American College of Cardiology begins to clarify the confusion regarding healthy people and fish oil. Based on ``compelling evidence'' from numerous studies, these researchers conclude that the evidence supports a daily intake of at least 500 mg of fish oil for healthy adults. This means that if you are not eating fatty fish twice a week, you might consider a supplement.

The most common negative side effects from fish oil supplements are nausea, stomach upset and a fishy burp. I have heard freezing the fish oil capsule before taking it can decrease the ``burps.'' The conversion of ALA (the omega 3 in flax and walnuts) to DHA and EPA is very low, and might not support all the cardiovascular benefits, so vegetarians could consider a marine-based DHA/EPA supplement.

Sheah Rarback is a registered dietitian and on the faculty of the University of Miami Leonard M. Miller School of Medicine. Her column runs every other week.

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