Omega-3, Fish Oils Prescription vs Supplement
Overview:
Consuming omega-3 fatty acids, particularly the long-chain omega-3s found in fish and seafood (also known as fish oil), has been associated with significant health benefits, such as reducing cardiovascular disease risk. However, recent national surveys have shown that adults in the United States are consuming significantly less than the recommended amounts of seafood and omega-3 fatty acids.
What is Omega-3?
Omega-3 fatty acids are a type of polyunsaturated fatty acids (PUFAs) with a specific chemical structure that contains a double bond in the third bond of the fatty acid chain. Of the various omega-3s, three have specifically been researched for their health effects: alpha-linolenic acid, docosahexaenoic acid, and eicosapentaenoic acid. (2) Fish provide a primary source of EPA and DHA in the human diet. Many fish feed on phytoplankton, which consumes microalgae, the aquatic organisms that produce PUFAs. (1)(2)
In theory, the essential fatty acid ALA, found in plant-based sources such as nuts and seeds, can be converted to the long-chain fatty acids EPA and DHA in the liver. As a result, EPA and DHA are not considered to be essential to obtain from the diet. However, conversion rates of ALA are generally less than 15%, increasing the need to consume dietary sources of EPA and DHA, such as fish, seafood, and omega-3 supplements. (2) Some of the more important health benefits of omega-3s also come from EPA and DHA, as opposed to ALA, so it’s important to ensure these are included in your diet or supplement plan.
In theory, the essential fatty acid ALA, found in plant-based sources such as nuts and seeds, can be converted to the long-chain fatty acids EPA and DHA in the liver. As a result, EPA and DHA are not considered to be essential to obtain from the diet. However, conversion rates of ALA are generally less than 15%, increasing the need to consume dietary sources of EPA and DHA, such as fish, seafood, and omega-3 supplements. (2) Some of the more important health benefits of omega-3s also come from EPA and DHA, as opposed to ALA, so it’s important to ensure these are included in your diet or supplement plan.
Known Benefits of Omega-3 and Sources
- Shows anti-inflammatory effects
- Improves symptoms of Rheumatoid Arthritis
- Plays a structural role in cells
- Assists with cardiovascular disease
- Reduces risk of cognitive decline and dementia
- Supports infant health and neuro-development during pregnancy (2)
Foods high in omega-3 include cold-water fish, oysters, and organ meats, providing EPA and DHA, as well as flaxseeds, chia seeds, leafy green vegetables, and walnuts, providing ALA.
Quality:
Natural Fish Oils
Omega-3 fatty acids naturally occurring in fish are found as triglycerides, which contain three fatty acid chains bound to a glycerol molecule, and free fatty acids. Natural fish oils contain approximately 18% EPA and 12% DHA.
Many fish oil supplements are derived from natural triglycerides that are processed to contain a higher concentration of EPA and DHA. (4) In contrast, omega-3 fatty acids in vegan omega-3 supplements are primarily in a natural triglyceride form.
Many fish oil supplements are derived from natural triglycerides that are processed to contain a higher concentration of EPA and DHA. (4) In contrast, omega-3 fatty acids in vegan omega-3 supplements are primarily in a natural triglyceride form.
Ethyl Esters
Ethyl esters, a concentrated form of omega-3 fish oil, are produced from natural triglycerides by replacing the glycerol molecule on the triglyceride with ethanol. (2) A study that compared the bioavailability of three concentrated forms of fish oil with natural fish oil, natural cod liver oil, and placebo found that ethyl ester fish oil concentrate supplements resulted in lower EPA and DHA serum levels than the other omega-3 formulations, suggesting that ethyl esters are less efficiently absorbed.
Prescription Fish Oils
Prescription fish oil in the United States is typically found in free fatty acid or ethyl ester forms. (5) Common prescription fish oils include Lovaza and Vascepa. Certain prescription fish oils consist of a self-emulsifying formula, allowing the omega-3s to be emulsified in the stomach. This improves the bioavailability of the omega-3s when consumed without a high-fat meal, which may be beneficial for individuals following a low-fat diet.
Be Careful of Contaminants in Supplements
Certain types of fish have been found to contain potentially harmful levels of environmental contaminants, such as mercury, polychlorinated biphenyls (PCBs), and organochlorines. Studies that have tested fish oil supplements report that levels of these toxins are typically below the detection limit. (6)(7) However, vegan omega-3 supplements, such as algal oil, may have a lower risk of contamination than fish oils.
Summary:
Historically, the human diet contained an equal ratio of omega-6 to omega-3 fatty acids. As our omega-6 intake has increased, so has the prevalence of chronic diseases. (8) Fortunately, taking omega-3 supplements is an effective and generally safe method to increase your omega-3 intake. (2) Stay informed about omega-3 supplements and consult with your integrative healthcare practitioner about which supplements are best for you.
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