Selecting An Omega-3 Fat or Fish Oil Supplement

Omega-3 rich fish oil softgels are an inexpensive source of EPA and DHA

Fish oil supplements get a lot of attention these days for improving cardiovascular health by reducing LDL cholesterol and triglyceride levels. Experience shows they are also often effective for reducing the severity of inflammatory conditions such as arthritis. Growing volumes of research show that the active ingredients in fish oil supplements, the omega-3 fatty acids, are critical to brain health.

As such, having too little omega-3 fatty acids in the body may trigger or worsen a wide range of neurological and psychiatric problems including low intelligence, depression, anxiety, hyperactivity, depression, aggression, and even conditions such as Bipolar Disorder, Borderline Personality Disorder, and autism.

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The omega-3 fatty acid DHA is a major ingredient in the brain cell membranes and the omega-3 fatty acid EPA appears to affect neurotransmitters. Thus the ties between nutritional deficiencies of omega-3 fatty acids and a variety of mental health impairments should be no surprise.

Obviously fish oil has some solid benefits. But with thousands of available products, often with one store having dozens of types, how do you pick a fish oil product for your own use? In this article, I’ll explain some of the features you should consider and illustrate them using fish oil products from Life Extension and Costco.

Fish Oil Contains Omega 3 Fats

There are three common types of omega-3 fats. These are EPA (eicosapentaenoic acid), DHA (docosahexaenoic acid), and ALA (alpha-linolenic acid). ALA tends to be predominately found in plant sources of omega-3 fats. Fish oil products generally contain EPA and DHA without any ALA.

The body can convert ALA to EPA and EPA to DHA. Unfortunately, these conversions are inefficient. It is better to consume a mixture of omega-3 fats rather than relying solely upon ALA.

Certain types of fish are the lowest priced sources of EPA and DHA. This is a major factor in the popularity of fish oil supplements.

Plant Sources of Omega-3 ALA Not Efficient

Supplements aren’t the only source for omega-3 fatty acids. Oily fish meat, flax seeds and oil, walnuts, pumpkin seeds, and some other foods contain omega-3 fatty acids, too. But many of them, particularly those coming from plants, provide alpha-linolenic acid (often abbreviated as ALA, sometimes as LNA) which must be converted into DHA and EPA in the body. The conversions are inefficient so a larger amount of ALA can be converted into just 1/10 to 1/20 the amount of EPA and DHA. But even then, some people’s bodies cannot convert large quantities of ALA to the other forms even if it is available.

(from The Vegetarian Society Information Sheet on Omega 3 Fats)

ALA is a precursor of the longer chain omega 3 fatty acids, eicosapantaenoic acid (EPA) and docosanexaenoic acids (DHA) which are both available in significant amounts in oily fish and fish oil supplements. The conversion rate of ALA to EPA in the body is estimated to be between 5 and 10%, although one study has reported a figure of 20% for young women. If DHA is not received through the diet it can only be derived from the body’s supply of EPA, therefore the overall conversion rate for DHA from ALA is even lower (usually below 4%). However it is important to remember that absolute amounts of ALA and LA in the diet also affect ALA conversion. Decreasing LA intake has been found to increase the proportion of ALA conversion to EPA, while increasing ALA intake can increase the absolute amount of DHA synthesised.

Scientists have observed that vegetarians and vegans have lower blood levels of EPA and DHA than people who eat fish. EPA, DHA, and certain vitamins (particular B family) generally occur in very small quantities in plant-sourced foods compared to animal-sourced foods. This is thought to be among the reasons why vegetarians and vegans often get a mixture of benefits and detriments from the lower-fat and higher-fiber features of their plant-based diets. If they would supplement with the nutrients in scarce supply in their diet, they would be able to more fully reap the potential health benefits. Vegetarians and vegans should in particular consider supplements containing EPA, DHA, B family vitamins, and possibly also the anti-glycation amino acid carnosine to be essential to good health for them.

Variations in the dietary intake of the omega-6 linolenic acid (LA) have a significant effect on the ALA to EPA/DHA conversions tending to cause more production of EPA by reducing LA or increasing ALA intake. Most people eating common Western diets get far too much linolenic acid (LA) compared to their intake of omega-3 fats.

Considering all of the above, for most people it is best to get your omega-3 fatty acids as EPA or DHA rather than trying to depend entirely upon plants and their ALA sources.

If you simply cannot tolerate fish oil supplements and don’t eat fish, there are some vegetarian omega-3 supplements containing EPA and DHA obtained from algae available.

Recommended Dosages of EPA and DHA

While health experts increasing proclaim the importance of omega-3 fats, there is little governmental guidance as to recommended consumption. My personal opinion is that almost everyone could benefit from taking at least 600mg of EPA plus DHA per day. Kids might seem to need less given their smaller size, but with their growing bodies the need for omega-3 fatty acids might be higher than their size would suggest. This is particularly true for infants and toddlers as their brains require large amounts of DHA for proper development. While mother’s milk can pass along DHA to a nursing infant, many mothers fail to consume enough EPA and DHA as their stores are depleted by the fetus during pregnancy and by the nursing infant.

It is common knowledge that pregnant and nursing women should take folic acid or folate supplements to help keep their babies healthy. Scientists increasingly believe that omega-3 supplementation is also critically needed for pregnant and nursing women and is a very safe and inexpensive way to safeguard and improve the health of babies. If you’re a pregnant or nursing mom, consider taking 1200mg or more per day of EPA plus DHA along with your neonatal vitamins.

The UK Vegetarian Society provides some guidance on omega-3 fatty acid nutritional requirements:

(from The Vegetarian Society Information Sheet on Omega 3 Fats)

There is no RDA for essential fatty acid intake and most of the guidelines are based on an intake of fatty fish. The European Food Safety Authority guidelines for daily intake, which were revised in 2009, recommend 2-3g ALA or 250mg EPA/DHA and 10g LA to support cardiovascular health and neurodevelopment. The American Heart Association is currently looking at levels of EPA/DHA daily intake closer to 500mg, which using a 10% ratio figure would imply a requirement of 5g ALA. Clearly a tablespoon of flaxseed oil per day would fulfill this.

Consider those as baseline recommendations for healthy people.

For those not in perfect health, many common conditions such as cardiovascular diseases and mental health difficulties appear to benefit from significantly increased levels of omega-3 consumption.

For most people who are not using anticoagulation therapies to reduce blood clotting, taking 1200mg of EPA plus DHA per day should be safe. There are some reports of slight elevations in blood sugar that may be of concern for diabetics. This can easily be monitored via standard testing. If it is a problem, switching to a supplement featuring a higher concentration of EPA and DHA may help.

Recommendations for omega-3 supplements for those with elevated cardiovascular disease risks are usually much higher. Often 1200mg of combined EPA plus DHA per day is recommended for people with borderline or mildly high triglyceride or LDL cholesterol levels, 1800 mg per day for moderately high levels, and 2400 mg per day for very high levels which unfortunately is quite common. Keep in mind even if your LDL cholesterol levels are not sky-high, your triglycerides may be and omega-3 supplements can help with this problem, too.

Dosages for people with elevated risk of blood clotting range even higher, even over 4800 mg per day.

While the understanding of omega-3 supplements as a substitute or complement for psychiatric drugs is still rapidly developing, it appears that most studies of fish oil supplements improving mental health have involved 1200mg or more per day of EPA plus DHA. Some use dosages of EPA plus DHA of 5000mg per day or more. Generally it appears that consuming a mix of EPA and DHA, rather than one or the other, works better.

Product Comparison

In fish oil supplements, the two most important components are the omega-3 fatty acids EPA and DHA. Typical products you see in stores are often labelled “Fish Oil 1000mg” or similar. While the volume of the entire supplement may be 1000mg, generally they have much less EPA and DHA. For common 1000mg fish oil capsules, most have a total of around 300mg of omega-3 fatty acids. It is common for this to be composed of 180mg of EPA and 120mg of DHA, but this can vary.

Thus it’s important to compare products based upon more than just the total size of the softgel. The EPA and DHA quantities are the most important piece of information, but other ingredients such as vitamin E, sesame oil, and olive oil can help preserve the omega-3 fatty acids from oxidation that reduces their effectiveness.

Fish oil products do go rancid, so be sure to check the expiration date. When buying in bulk from a vendor with rapid inventory turnover, it is common for expiration dates to be at least a year in the future.

As with most supplements, fish oil is best stored in dark, cool locations that will slow the degradation of the product from normal oxidation and other chemical reactions.

If you’re concerned about cholesterol levels, you might note that some products have several times the amount of cholesterol as others.

Some people have a bit of digestive discomfort from fish oil. As a result, some makers have introduced enteric coated softgels that won’t break down in the stomach. They are digested starting in the intestines. These products are usually a bit more expensive and unnecessary for most people. By taking fish oil supplements with meals and gradually ramping up the dosage when starting or increasing dosages to give the body some time to adjust, even many of those who might otherwise experience discomfort can avoid or reduce it.

In the chart below, I’ve provided a comparison between four omega-3 fish oil products from Life Extension and Costco. Although the basic Costco product is the cheapest, it has a low concentration of EPA and DHA along with relatively high cholesterol levels. If you were to take 2400mg of EPA plus DHA per day, by taking the necessary 8 softgels per day of that supplement you’d be getting 80mg of extra cholesterol (about 25% to 40% of the typical daily cholesterol intake) and 80 calories mostly from fat. Using any of the other three products in the table can significantly reduce the number of softgels and the cholesterol and fat.

From left to right, Life Extension Mega EPA/DHA, Costco Kirkland, and Life Extension Super Omega-3 fish oil softgels

I’ve used each of these products except for the more expensive Costco softgel. For people who have trouble swallowing what are generally relatively large fish oil softgels, the Life Extension Mega EPA/DHA softgel (on the left side of the adjoining photograph) is the smallest of the three. The basic Costco softgel is just slightly larger. The Life Extension Super Omega-3 softgel (on the right side of the photo), with its extra olive oil, is the largest. Note that I didn’t have a bottle of the Kirkland Enteric Coated Fish Oil available for a photo but that it is about as large as the softgel on the right.

Keep in mind that prices at Costco stores vary somewhat. I’ve used the Life extension and Costco online pricing current as of July 29, 2010. Also note that shipping is often free via Life Extension but is usually additional from Costco.com. You can of course avoid the shipping by buying in a local Costco, but do be aware that based upon my past observations that sometimes the in-store prices is a little higher (maybe as much as $1) higher than the on-line price for these products.

Comparison of Omega-3 fish oil supplements	Life Extension Mega EPA/DHA Fish Oil	Super Omega-3 EPA/DHA with Sesame Lignans & Olive Fruit Extract	Costco Kirkland Fish Oil	Costco Kirkland Enteric Coated Fish Oil
EPA + DHA (mg)	600	600	300	684
EPA (mg)	360	350	not stated	410
DHA (mg)	240	250	not stated	274
Vitamin E (IU)	4	yes, amount not stated	not stated	not stated
Olive fruit extract	none	300mg	none	none
Sesame lignan extract	none	10mg	none	none
Calories	10	10.5	10	10
Cholesterol (mg)	4	4	10	10
Price per container	$6.98	$18.68	$8.99	$15.39
Softgels per container	120	120	400	180
Price / softgel	$0.0582	$0.1557	$0.0225	$0.0855
Price / 1200mg	$0.1163	$0.3113	$0.0899	$0.1500
Daily dosage of 1200mg of EPA+DHA per day (typical dosage)
Softgels per day	2	2	4	2
Calories per day	20	21	40	20
Cholesterol per day (mg)	8	8	40	20
Annual cost	$42.46	$113.64	$32.81	$62.42
Containers per year	6.08	6.08	3.65	4.06
Daily dosage of 2400mg of EPA+DHA per day (high blood lipid dosage)
Softgels per day	4	4	8	4
Calories per day	40	42	80	40
Cholesterol per day (mg)	16	16	80	40
Annual cost	$84.92	$227.27	$65.63	$124.83
Containers per year	12.17	12.17	7.3	8.11

NOTE: The information in the chart above was accurate as of the time the article was written. However, manufacturers may modify the content of their products so new formulations may differ from those discussed in this article.

Consider Entire Price Including Tax and Shipping

If you’re shopping mainly on price, recompute the pricing to include shipping, sales tax (generally not charged by Life Extension), and whatever the price of the moment is for each product. My personal opinion is that the Life Extension Mega EPA/DHA Fish Oil is generally the best deal once you consider all of these factors and how it includes far less cholesterol than with the Costco products and is likely to last a little longer because of the added vitamin E to slow its oxidation to prevent it from becoming rancid as rapidly. The only one of these products I don’t use on a regular basis is the Costco Kirkland Enteric Coated Fish Oil. I haven’t had any problems with digestive upset so don’t want to pay extra for the enteric coating. I rely mostly on the Life Extension products with most of my fish oil intake coming from Life Extension Mega EPA/DHA Fish Oil.

Tips for Using Omega-3 Fish Oil Products

With fish oil, as with many supplements, it is generally best to start with a small dose and work your way up as your body gains familiarity with the supplement. Generally it is believed to take at least a few weeks for the benefits to begin to appear, but for mental health applications it may take much longer. While there is no solid conclusion on why, it may be due to having to restore very large deficiencies of DHA in brain tissue that have developed over the course of years.

Be sure to take fish oil products well apart from dietary fiber supplements and other supplements that reduce fat absorption. Omega-3 EPA and DHA are fatty acids that the body will better absorb if they are not soaked up by fiber supplements.

If you are taking dietary supplements that inhibit fat absorption, you should take fish oil supplements several hours before or after these supplements. Many such supplements work by inhibiting the lipase enzyme necessary for digesting fat. Products that contain lipase enzyme inhibitors include Life Extension’s Enhanced Irvingia with Calorie Control Complex and GlaxoSmithKline’s Alli (Orlistat). By the way, these two products really do work well. A friend of mine has been taking them on a daily basis for about two months and has lost nearly 10 pounds as they help reduce his appetite and reduce the number of fat and carbohydrate calories absorbed. He also takes Mega EPA/DHA, but times it to be several hours before or after dinner when he takes the Irvingia and Alli supplements along with fiber supplements including oat bran, psyllium, gymnema sylvestre, and a colon cleanser product. The fiber supplements help absorb excess fat and flush it out of the body, thus reducing some of the side effects from lipase inhibitors leaving undigested fat in the intestines.

Omega-3 fish oils made by reputable manufacturers do not have mercury, PCB, and other similar contamination found in fish meat itself. Please see our previous article Statin Side Effects, Risks, and Alternatives for more information.

As mentioned earlier, pregnant and nursing women in particular need a lot of DHA because DHA is critical to the growth of fetal and infant neural and nervous systems, especially the brain. Pregnant women should get their omega-3 intake from supplements that are mercury-free rather then from fish that is much more likely to be contaminated with levels of mercury that could harm an unborn or nursing baby.

Fish oil supplements may “thin” the blood and thereby decrease the risk of clots and increase the risk of uncontrolled bleeding. If you are taking anticoagulant or antiplatelet medications such as Coumadin, warfarin, or Plavix, be sure to tell your doctor about taking fish oil supplements as they may affect the medicine dosage you should take. You may want to discuss with your doctor taking high-dosage fish oil at 3000mg per day or more in conjunction with supplements such as nattokinase and enteric-coated bromelain that can help reduce inflammatory conditions and high fibrinogen levels that can result in dangerous blood clots, heart attacks, and strokes. Recent studies show that such supplements work independently of vitamin K antagonist drugs such as warfarin and Coumadin, so your doctor may consider using them in conjunction or in place of such drugs as these supplements may help lessen diet-dependent effect variability and long-term side effects such as increased arterial calcification and atherosclerosis.