Sorting out omega-3 supplements

Omega-3 fatty acids are one of the most — if not the most — popular supplements on the market.  They come in different brands and different doses and different forms.  It can get confusing.  If you’re taking one, how did you choose it?  Full disclosure: I’ve been taking omega-3 for many years, and sometimes I’m even confused about which one to pick.  Do high doses confer any health benefit?  Is the triglyceride form better than the ethyl ester?  Are capsules better than liquids?  What to do?

While you’re evaluating all the choices, you might be wondering: how do I know the supplement is providing any benefit?  And truthfully, you might not know, or at least might not notice anything for months. That’s because omega-3 fats are nutrients that are incorporated into many metabolic pathways and biological structures.  If you add them to your diet, the process of moving them into membranes or cell structures can take time.  It’s not like taking an antibiotic and seeing results in a day.  Changes will be slow and probably subtle, not dramatic.  Let’s face it, taking omega-3 supplements is something of a leap of faith.  Here’s how I see it: omega-3 fatty acids are critically important for plenty of metabolic systems.  Intake is linked to improvement in many health outcomes.  I’m confident that if I add them to my diet they will enhance my overall health.

Brief Review of Omega-3 Fatty acids:

  1. Alpha linolenic acid (ALA): 18 carbon length chain, found in plant foods such as flax, walnuts, canola.  Must be metabolized to longer chain length for biologic activity. Humans ability to metabolize ALA is limited.
  2. Eicosapentaenoic Acid (EPA): 20 carbon length chain.  Important for inflammation and other metabolic processes. Sourced from fatty fish like salmon, and other ocean species.
  3. Docosahexaenoic Acid (DHA): 22 carbon length chain.  A key component of eye and brain tissue and important for nerve function. Can be sourced from algae as well as from fish.

These are the three most important omega-3 fatty acids in our diets.  Vegans and vegetarians may have limited intake of the biologically important EPA and DHA because they avoid fish-sourced products.  In recent years, DHA has been produced from algae, but EPA production from algae is not as plentiful so far.  It’s possible that in the future, omega-3 supplements will be sourced more from algae and other bio-industrial methods, leaving fish out of the equation.

How Much Should You Take?

While most supplemental omega-3 is purchased over-the-counter, some people are prescribed a special high dose omega-3 to treat high triglycerides.  Prescription doses are extremely high — around 4000 mg (4 grams) per day; it’s unlikely you’d find an OTC supplement with that dose, and in any case it would be extremely expensive.  It’s also not necessary for the average person.  As with all things nutrition, a reasonable intake of a nutrient is good; an excessive intake almost never creates an additional health benefit.

The suggested US Adequate Intake for total combined omega-3 fats (ALA + EPA + DHA) is 1.1 grams for women and 1.6 grams for men.  Only 10% of that total needs to be EPA/DHA, which equals 110 to 160 mg.  Other countries and organizations have different ideas.  Here are a few examples:

  1. WHO:  intake of all omega-3 equal to 1-2% of total energy.  This could mean a man consuming 2000 calories/day could consume 4 grams/day of total omega-3.  In countries where little or no high omega-3 fish is consumed, that means much of that total will be the plant-based form ALA.  One example is India.
  2. European Food Safety Authority:  250 mg EPA/DHA
  3. France: 500 mg EPA/DHA
  4. Nordic Council:  1% of energy (our example man above would consume 2 grams/day)
  5. Academy of Nutrition and Dietetics:  500 mg EPA/DHA
  6. Japan Ministry of Health:  numerous specific recommendations depending on gender and age. For the general adult population, the recommendation is more than 1 gram/day.  But the recommendation is greater than 2 grams for teens, and 2 or more for older adults.

Omega-3 supplements focus on the biologically important EPA and DHA, which are typically derived from fish.  These two omega-3s are typically listed both separately, and as a total.  In most supplements, other fats are included in the capsule.  So while a supplement might say “500 mg of omega-3”, the supplement might have 1000 mg total fat.  When purchasing a supplement, pay attention to the EPA/DHA listing, not the total fat.  In other words, a 1 gram (1000 mg) capsule might only have 500 mg of omega-3.

Unless you have a specific medical or health issue that dictates some particular amount of omega-3, I think the 500 mg combined EPA/DHA dose is fine.  There are many supplements with doses in this general range.  Or course, if you are a frequent consumer of fatty fish like salmon or mackerel, you probably don’t need any supplementary omega-3. For example, the daily intake in Japan is significant thanks to the high intake of fish.

What Form?

Decades ago, cod liver oil was the original form of omega-3 supplement, although few people understood it that way.  Rather, it was recognized as a source of vitamins A and D.  But cod liver oil tastes pretty strong — fishy and liver-y, so wasn’t a mainstream health tonic.  Liquid forms of fish-sourced omega-3 are now are flavored and texturized to make them much more palatable.  If you are vegetarian or vegan, you can find flax or algal oils.  Keep in mind, flax is not a natural source of EPA and DHA, so flax supplements will only provide ALA.

Choosing between capsules or oil is going to be a personal choice.  Some people don’t like swallowing large capsules.  Some people want to be able to tell if a product is rancid — easy to do with liquids, hard to do with capsules.  And liquid forms can easily be blended into smoothies, so if a daily smoothie is on the menu, you might want to consider that.

For capsules, another form decision is triglyceride vs. ester.  This refers to the structure of the omega-3 carrier molecule in the supplement.  The triglyceride structure has 3 omega-3s attached to a carbon backbone.  The ethyl ester only has 2 omega-3s attached.  This has nothing to do with the omega-3 fatty acids themselves.  In either case, they are cleaved off the carrier backbone and absorbed.  Some people claim the ethyl ester form is not a natural form, and prefer the triglyceride form.  The triglyceride form is harder to produce and more fragile and susceptible to heat damage and rancidity.  Triglyceride form products are usually more expensive.  How can you tell which is which?  You usually can’t.  Unless the company actually states on the label “triglyceride form”, you might not know.  In general, cheaper brands are probably ethyl ester.  For all varieties, storing in a cool location out of direct light is essential.  The refrigerator works fine.

My preferences

I’ve taken capsules of fish-sourced omega-3 for many years.  Recently I started using a liquid supplement, just to see how that would work out.  I must say, I like it.  This particular brand has a lemony smoothie flavor; I’ll probably stick with it for awhile.  I’m not personally a fan of the straight fish oil varieties.  They may have flavoring, but you still get the sensation of eating a spoon full of oil.

But capsules are fine and convenient.  Another plus: you can pack them along while traveling.  Whatever form you use, take it with food.  After all, the natural vehicle for omega-3 fatty acids is food, whether walnuts or salmon or flax or sardines.  Fat absorption is a specialized process stimulated by food in the intestines, and if you’re going to the expense of buying an omega-3 supplement, you want to maximize absorption.

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