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Independent Univera Associates What You Need To Know About Fish Oil Why all the fuss about fish oil? It's all about the omega-3 fatty acids found in fatty, cold-water fish like salmon, lake trout, anchovies, halibut, whitefish, striped sea bass, mackerel, herring, sardines and albacore tuna. These omega-3 fatty acids are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), and Americans don't get enough of them. The typical American diet of processed foods and hydrogenated oils laden with omega-6 fatty acids has altered the omega-6 to omega-3 ratio to well over 10:1 instead of the ideal ratio of about 2:1. This great imbalance promotes inflammation in the blood that is known to be a key factor in heart disease as well as many other inflammatory diseases such as arthritis, asthma, dementia and certain cancers. Another kind of omega-3 fatty acid, ALA (alpha-linolenic acid), which is found in tofu/soybeans, walnuts, canola and flaxseed oils, and dark green leafy vegetables like collard greens, has also been widely studied and found to be beneficial for the prevention of stroke and certain cancers, but not unequivocally. The association between ALA and heart disease is even less clear. ALA can be converted to EPA and DHA in the body, but this conversion is inefficient. Therefore, one cannot depend on the consumption of ALA to get adequate amounts of EPA and DHA. To get EPA and DHA, you must eat fish or take fish oil supplements. Omega-3 fatty acids are one of the most extensively studied food supplements with well- documented benefits noted in hundreds of epidemiological studies and clinical trials. Fish oil supplements are currently widely used by medical doctors to lower high triglyceride levels and to reduce the joint pain of arthritis. Several trials in people with a history of heart attack have shown that omega-3 supplementation reduces the risk of fatal and non-fatal heart attack, sudden death and death due to any cause. Proposed mechanisms for these beneficial effects include their ability to slightly lower blood pressure, reduce inflammation, reduce blood clotting, decrease the rate of growth of cholesterol plaque that builds up in arteries, and decrease the risk of rhythm abnormalities that lead to sudden cardiac death. Other studies have shown their anti-inflammatory effects benefit conditions such as lupus, rheumatoid arthritis, asthma, emphysema, Crohn's disease, ulcerative colitis and Alzheimer's disease. Omega-3s have also been shown to improve hot flashes, migraine headaches, dyslexia and psychiatric conditions such as depression, attention deficit hyperactivity disorder (ADHD), test anxiety and suicidal tendencies. A recent study showed omega-3s can even boost children's IQ when taken by women during pregnancy. The World Health Organization recommends consuming 800-1100 mg of ALA and 300-500 mg of EPA and DHA per day. The American Heart Association (AHA) recommends people without documented heart disease to consume fish at least twice a week and to consume ALA-rich foods such as flaxseed and walnuts. For people with documented heart artery disease, they recommend consuming 1000 mg of EPA + DHA per day, and to lower triglycerides, 2000-4000 mg per day. Secondary prevention studies for ALA have used doses in the 1500-3000 mg per day range. Arthritis studies have shown benefits using EPA and DHA doses in the 3000-5000 mg per day range, but a recent study showed reduction of joint pain when taking as little as 2400 mg per day. Many experts feel the AHA's recommendations for omega-3 fatty acid consumption are inadequate, and that Americans should be consuming closer to 2000 mg of EPA + DHA per day to restore the critical omega-6 to omega-3 imbalance present in our society. Many people confuse the amount of EPA + DHA with the amount of fish oil noted on supplement bottles. One should ignore the amount of fish oil noted on the front of the bottle and look at the back of the bottle where the amounts of EPA and DHA are listed. Add the amount of EPA and DHA together in each serving, and then take as many servings necessary to achieve the desired dose. So who should not take fish oil? Fish oil supplements are widely considered to be very safe, but given their tendency to thin the blood, they should not be taken by people who are anticipating surgery, have a bleeding disorder or an increased propensity to bleed, or have had a stroke where bleeding was present in the brain. For people taking blood thinners such as aspirin and coumadin, they should only be taken under the discretion of a healthcare practitioner, though concern typically exists only with EPA and DHA doses above 3000 mg per day. The benefits of omega-3s have also come into question in certain types of heart patients. People who have had a heart attack before appear to benefit the most from omega-3 supplementation, but in those who have implantable cardioverter-defibrillators (ICDs), at least one clinical trial showed that some individuals taking omega-3s actually had more heart rhythm problems than those who were not taking them. Another trial showed an increased risk of cardiac death with fish oil supplementation in people with angina pectoris (chest pain due to heart disease.) It is probably best for individuals with ICDs and angina pectoris to avoid fish oil supplementation until further studies indicate otherwise. Buying a quality fish oil supplement is very important, as impurities and oxidation can negate the beneficial effects of omega-3 fatty acids. Impurities such as dioxin, PCBs and heavy metals like mercury and lead must not be present, so it's important to buy from a reputable manufacturer. Also very important, but rarely mentioned, is the level of oxidation present. Oxidation from exposure to light, heat, metals and oxygen damages fish oil. An adequate amount of Vitamin E should be added to the fish oil to prevent this oxidation both in the pill and in the body after it is ingested. A good way to tell if a significant amount of oxidation has occurred in the bottle is to smell it. A fishy smell is a bad sign, and suggests that the oil has become rancid. Refrigerating the supplement is also a good idea to help prevent rancidity, and even freezing fish oil tablets has been recommended for people wanting to avoid annoying fish burps. Fish oil comes in both liquid and tablet forms, in ethyl ester and triglyceride forms, and most are purified by molecular distillation and a few by carbon dioxide techniques. Though liquid forms offer considerably higher amounts of EPA and DHA per serving, levels of oxidation tend to be higher since the oil is open to air and not encapsulated as they are in pill form. The natural form of fish oil is the triglyceride form. It has a higher bioavailability than the chemically modified ethyl ester form, but in my opinion, not enough to justify the considerably higher cost. Even the only pharmaceutical grade prescription form of fish oil on the market (Omacor) comes in ethyl ester form. The same goes for the purification and concentration abilities of carbon dioxide techniques over molecular distillation. Significantly higher doses of EPA and DHA can be achieved by carbon dioxide purification, but the much higher cost makes it a less attractive option for most people. Grocery store brands are typically in the ethyl ester form and come in 1000-1200 mg fish oil softgels containing usually 300 mg of total EPA and DHA per pill, but sometimes 440 mg. Most reputable stores do well in terms of avoiding contaminants, but not well at all in terms of oxidation levels. Also, the relatively low levels of EPA and DHA per pill make it difficult for people wanting to take doses of 3000 mg per day for their arthritis pain, because they would have to take ten pills a day. Other over-the-counter brands are available with as much as 750 mg or more of omega-3 fatty acids per pill, but few are reasonably priced. In conclusion, I believe fish oil to be the number one food supplement for general wellness. Omega-3 fatty acids are involved in every physiological process in the body, and hundreds of studies show they can benefit the heart, improve memory, IQ and emotional well-being, and many other conditions outlined above. Societies who consume significant amounts of fish have very low levels of cardiovascular disease and are generally healthier than ours. Americans simply don't eat enough fish. We get mixed messages about needing to eat more fish, then hearing how dangerous wild fish can be due to toxins such as mercury. Some give farm-raised fish a bad rap as well because of what they are fed. However, a recent article from the Journal of the American Medical Association concluded that the benefits of fish intake exceed the potential risks. If you don't like fish but still want the benefits of omega-3s, don't eat 2-3 fish servings a week, don't want to take chances with contaminants, or simply want to consume a larger amount of omega-3s than you care to eat in fish, then fish oil supplementation is the way to go. Most Americans fit in at least one of these categories, and I feel just about every one of us could benefit from supplementation. April 2007 --------------------
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