Omega-3s in Fish Oil and Supplements: What’s Your Best Strategy?

If you’re thinking about adding an omega-3 fatty acid supplement to your daily regimen, there are things to consider first. Do you really need one? What type of supplement should you choose? What are the risks?

Who Needs More Omega-3s?

The evidence suggests that just about all of us could stand to get more omega-3s in our diet. Many experts believe that the level of healthy omega-3s in the average U.S. diet has plummeted in the last century.

Increased intakes of omega-3s may be especially important to people with certain diseases or risk factors. Studies have found very strong evidence that omega-3 fatty acids may help:

• Boost heart health
• Control triglycerides
• Lower blood pressure

There’s good evidence that omega-3 fatty acids may help with lots of other conditions too – including depression, rheumatoid arthritis, asthma, ADHD, osteoporosis, and more.

Omega-3s: Supplements vs. Diet

In general, experts say that it’s always best to get nutrients from food. So if you’re looking to get more omega-3s in your diet, eating fatty fish – like salmon, trout, or sardines – two or three times a week is the best way to do it. Fish contain DHA and EPA omega-3 fatty acids, the type most beneficial. Plants contain ALA omega-3 fatty acids, less potent but still good for you. You find ALA in foods such as walnuts, flax, and canola oil.

What about supplements? Experts stress that popping an omega-3 supplement can’t excuse an unhealthy diet. That said, many people are resistant to changing the way they eat. Eating more fish may not be an option for vegetarians -- or for people who just don’t like it. For them, omega-3 supplements, algae oil capsules, or products fortified with algal oil DHA may be a good choice.

Even for people who are healthy and eating well, experts say that adding a daily omega-3 supplement might not be a bad idea. After all, the benefits of omega-3 supplements are numerous and the risks are very low.
Omega-3 Fatty Acid Supplements: Animal and Plant Sources

There are three types of omega-3 supplements you can buy. The most popular is fish oil, which is made from various fish like anchovies and sardines. It contains two omega-3 fatty acids, EPA and DHA.

Other supplements are derived from plant sources, like flax, or are derived from algae oil. Plant sources contain ALA, which is broken down minimally into EPA and DHA in the body. Another source of fatty acids is algae oil, which contains DHA; and many foods are fortified with this as a source of DHA.

So which should you chose? Many experts recommend going with fish oil for several reasons. EPA and DHA from fish oil have been studied much more extensively. Algae sources of omega-3's contain DHA, but not EPA. Lastly, only a minimal amount of ALA is actually converted into DHA and EPA in the body.

However, if you’re a vegetarian -- or you just can’t tolerate fish oil – considering plant-based omega-3 supplements is a reasonable idea. There are also many products fortified with DHA from algae oil and DHA capsules for those who do not eat fish.
Omega-3 Fatty Acid Supplements: Dosage

It’s always best to ask your doctor about what dose of omega-3 supplements you should take.

In general, most experts recommend 1 gram of DHA and EPA (combined) from fish oil. However, for specific conditions your doctor might recommend up to 4-5 grams per day. No one should take such high doses without medical supervision.

Here’s one problem: many people get confused about the dosage. Why? Because they don’t realize there’s a difference between a gram of fish oil and a gram of its active ingredients (the omega-3s DHA and EPA.)

Doctors want you to take a gram of omega-3s – the EPA and the DHA added together. But depending on the brand, a one gram (1,000 mg) fish oil capsule may contain only 300 mg of DHA and EPA combined. So to get one gram of omega-3s, you’d have to take four capsules – four grams of fish oil.

So keep that in mind. Ignore the amount of fish oil and focus only on the amount of DHA and EPA inside it.

The ideal dose of an ALA supplement is not so clear. There’s less evidence and more variability in how a person’s body will convert it into omega-3s. You could ask your doctor for advice or just follow the directions on the label.
Choosing an Omega-3 Fatty Acid Supplement

When you’re standing in the supplement aisle of the drugstore, it can be hard to know how to choose a brand. What should you look for in an omega-3 supplement? Here are some tips.

• Ask your doctor or pharmacist for a recommendation. This can save you a lot of trouble. They may have a favorite brand and know how to get it cheaply.
• Ask your doctor about prescription omega-3s. Some pharmaceutical companies are putting out their own fish oil supplements. While pharmaceutical fish oil may not be superior to over-the-counter supplements, it could be covered by your insurance. That could save you some money.
• Look for independent testing. Many supplement manufacturers have their products evaluated by an independent third party, like ConsumerLab.com or IFOS (International Fish Oil Standards). These groups test supplements to make sure that the supplements contain what the supplements claim. They also confirm that the products are purified and free of any toxins – like mercury and PCBs. Look for evidence of independent testing on the label or research a brand online.
• Decide how you want to take it. Omega-3 supplements most often come as capsules. But other forms are available, like liquid oils. Some energy bars and other foods are now augmented with omega-3s.
• Consider capsules with enteric coating. The most common complaint about fish oil is that it causes heartburn and burping. Enteric-coated capsules may reduce the problem.
• Check the ingredients. Look for supplements which have high levels of EPA and DHA per gram of fish oil. The higher the amount of EPA and DHA in each capsule, the fewer you’ll have to swallow.

Omega-3 Fatty Acid Supplements: Side Effects

On the whole, omega-3 supplements seem to be very safe. The most common side effects from fish oil are indigestion, diarrhea, and “fishy burp.” But here are some other things to consider:

• Fish oil supplements (EPA/DHA) may thin the blood. Although this effect is mild and safe for most people, no one should take a dose of above 1 or 2 grams without checking with a doctor first.
• If you have a health condition that affects the blood’s ability to clot, talk to a doctor before using these supplements at any dose. The same goes for anyone taking medicines or supplements that thin the blood, like Coumadin, Plavix, garlic, and others. Signs of trouble include easy bruising and increased bleeding -- in the gums, for instance. If you have any of these symptoms, stop using the omega-3 supplement. There appear to be separate effects from EPA and DHA; see your doctor right away. DHA has not been associated with bleeding problems.
• Pregnant women and children should also get the OK from a doctor before using an omega-3 supplement.
• Many people are concerned about the risk of contaminants – like mercury – in fish oil. While certain fish like swordfish and shark can have risky levels of these contaminants, fish oils seem to be safer. Fish oil is usually made from smaller fish that are less likely to build up toxins. Still, you should always look for a brand that has been deemed safe by an independent lab.

Tips for Using Omega-3 Fatty Acid Supplements

• If one brand doesn’t work, try another. If you don’t like the side effects of a supplement or feel like it’s not helping, try a different one. Experts say that some brands just work better in certain people.
• Always take supplements with food. It’s one way to reduce the risk of upset stomach.
• Store fish oil supplements in the freezer. It will keep the fish oil fresh and may reduce side effects like burping and indigestion.
• Consider alternatives to fish oil supplements. If the side effects from fish oil are just too bothersome, try a different approach. Push yourself to eat fish two or three times a week. Or opt for a plant-based supplement instead.
• Ask your doctor about using omega-3 supplements alongside your standard medicines. Omega-3 supplements can be a good complement to some standard drugs. For instance, omega-3 supplements can boost the effectiveness of some antidepressants and cholesterol medicines. What’s the benefit? By taking the omega-3, you may be able to get the same benefit with a lower dose of your prescription drug.
• If you have a medical condition, never start using omega-3 supplements as a treatment on your own. Although everybody should check with a doctor before using a supplement, it’s crucial if you have a health condition. Instead of treating yourself, work together with your doctor to come up with a comprehensive treatment plan.

Diet and Nutrients , Dietary Supplements