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If you like to peruse medical journals in your free time (like me!), you may have noticed a lot of conflicting research when it comes to fish oil and Omega-3s. Even if recent studies aren’t your choice for light reading, it’s important to understand the implications of fish oil and omega-3 consumption.
What I take and feel good about giving my family has changed over the years as I’ve read, studied, and learned more. Read on to learn what I’ve found in my research and what I use now.
What are Omega-3s and Fish Oil?
Let’s start at the beginning.
These terms are often used interchangeably in most literature but they don’t always refer to the same things. Fish oil can refer to any oil that comes from a marine source. This doesn’t differentiate the source, the breakdown of the Omega-3s (EPA and DHA), and doesn’t necessarily require manufacturers to specify the amount.
The group of fats known as Omega-3 fatty acids are well-documented for their health benefits. Sourcing and ratios are controversial, but more on that below. The term omega-3s most often refers to a group of fatty acids. The most well known, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), are found in fish sources. ALA (alpha-linolenic acid) is found in plant sources like nuts and seeds, though evidence suggests that the body can’t efficiently use ALA like it can DHA and EPA.
Now on to the research…
Omega-3 fatty acids are vital for many aspects of health, and many of us are not getting enough of them. But that doesn’t necessarily mean we should just start chugging the fish oil. Source matters and there are some big problems with certain types of fish oil supplements. More on that below, but Omega-3s (from high quality sources) have many benefits.
The University of Maryland Medical Center explains that Omega-3 fatty acids from fish may be useful for:
- Reducing the risk of heart disease and causes of death associated with heart disease
- Decreasing severity of symptoms associated with diabetes
- Alleviating pain associated with rheumatoid arthritis
- Reducing risk of osteoporosis and bone loss
- Improving health and reducing symptoms for those with autoimmune disease
- Helping those with anxiety, depression or bipolar disorder
- Reducing risk of various types of cancers
- Improving cognitive function
As I explained before, there are two main types of Omega-3s:
- Alpha-linolenic acid (ALA), found in certain vegetable oils, walnuts, and some green vegetables.
- The other type, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), is found in fatty fish.
The body can convert some ALA to EPA & DHA but is not very efficient at this process, so it is important to also consume sources of EPA/DHA. These nutrients are especially recommended during pregnancy and nursing (and are in most prenatal vitamins) because only certain forms of DHA are transferred across the placenta.
Omega-3 vs. Omega-6 = Ratio Matters
Omega-3s are important, but what is even more important, is consuming a healthy ratio of Omega-6 (n-6) and Omega-3 (n-3) fats. In fact, I suspect that we will find over time that this ratio is the confounding factor in fish oil research.
Both Omega-3 and Omega-6 fats are considered polyunsaturated fats because they have many double bonds. In general, we need much smaller amounts of these fats than we do other fats like saturated and monounsaturated fats, but they are still vitally important. Our bodies aren’t able to produce polyunsaturated fats so we must get them from diet (this is the reason they are called “essential fatty acids”).
Omega-6 fats are found in many processed foods, vegetable oils, processed grains, and soy. Omega-6 fats increase inflammation while Omega-3 fats can help reduce inflammation. Since n-6 fats are present in many processed foods, it is easy to understand why most of us get plenty of these in our diets. In fact, many people get way too much in their diets! (source)
The ideal ratio of Omega-6 to Omega-3 fats is thought to be around 1:1 (and not higher than 4:1). Most people are consuming much higher amounts of Omega-6 fats (up to 30:1). Higher amounts of Omega-6 can contribute to inflammation within the body and to disease.
Of course there are two ways to change this ratio: increasing Omega-3 consumption or decreasing Omega-6 consumption.
The Sourcing Matters… A Lot
Omega-3s (like all nutrients) are best obtained from food. In fact, the research documents a strong inverse relationship between fish consumption and heart disease and death. In other words, generally, the more fish a population eats, the lower its rates of heart disease and all causes of death.
The same unfortunately can’t be said about fish oil supplementation. In fact, this is where the controversy starts.
I have read studies that indicate that fish oil reduces heart disease. Other studies show it has no affect or may be harmful to the heart.
Some studies show that fish oil supplementation is good for the brain. Others show a negative effect.
Studies claim that fish oil helps improve insulin sensitivity and reduces diabetes risk. Other meta-analysis results show no benefit over the long term.
Ratio and Source of Fish Oil
In my opinion, the abundance of conflicting info indicates three things:
- A strong genetic component to fish oil needs between populations and people
- Lack of differentiation among types and qualities of fish oil in studies
- Not taking into account the Omega-3 to Omega-6 ratio in the body
I strongly suspect that further research will indicate that the ratio is a critical key in understanding Omega-3. Getting the benefits won’t just be about taking a fish oil supplement, but also reducing Omega-6 consumption. This is one of the reasons I avoid vegetable oils and margarine at all costs. These are very high sources of Omega-6!
Best Fish Oil Source? Fish!
This may be shocking, but the best source of fish oil is fatty fish! Consumption of quality sources of fatty fish (like sardines) is the most well-studied beneficial source of Omega-3.
I’ve always said that food should come before supplements as a priority and never is this more true that with fish. If the budget is tight or you aren’t sure about fish oil supplementation, eating fish is a great way to go.
Our family incorporates fatty fish like sardines at least a couple times a week as a source of Omega-3. I order high-quality sardines in bulk from about once a month. We also order high-quality low-mercury fish and incorporate them into our diet.
That said, some people don’t like or don’t eat seafood. In these cases, fish oil supplementation may be helpful, depending on source, genetics and dose. Fish oil supplements are increasingly popular with concerns about environmental toxins and heavy metals. We still prefer whole-fish sources whenever possible and make sure to order high quality fish where metals and radiation aren’t a concern.
Fish Oil Supplements: What I’ve Used
This is where the waters get murky. I highly recommend doing your own research on any supplements, including fish oil. All fish oil supplements are not created equal. Certain forms of fish oil contain altered forms of Omega-3s and can actually contribute to inflammation in the body.
Many Omega-3 supplements are in ethyl ester form, which is an altered form created when ethanol is fused with the fish oil. This creates an extremely pure fish oil concentrate, but not one that is very bioavailable. These types of fish oils are often hard to digest and can oxidize easily. The real difference, however, is in the digestion of these different types of fish oils. The natural triglyceride form breaks down in the small intestine and can be easily absorbed. Fish oils in the ethyl ester form are much more difficult for the body to break down and are not absorbed as easily once broken down. (source)
The natural triglyceride (TG) form is purified but still in a form that the body recognizes and can easily digest. It can be taken without food and doesn’t go rancid or smell strongly.
My Fish Oil Criteria
Searching for an Omega-3 supplement should always meet the following criteria:
- Natural Triglyceride form of Omega-3
- Concentrated doses of EPA and DHA
- Sustainably sourced (krill oil populations are declining so I prefer sources like anchovy or sardine which are more sustainable)
- Free of contaminants and heavy metals
- At least 2 grams of concentrated Omega-3s without having to swallow a handful of pills
This Omega-3 supplement meets those criteria and doesn’t have a fish aftertaste. This is the one I take when I need extra Omega-3s.
Fish Oils & Omega-3s: Bottom Line
We know fish is healthy. Studies show a strong link between consumption of fish and longer life and reduced heart disease risk. Most doctors have suggested seafood consumption for years and the research backs this up. In the light of recent concerns about heavy metal toxicity and radiation, it is important to choose high quality seafood. Sardines are a great food source of Omega-3 and are inexpensive and easy to eat on the go. In fact, most fish oil supplements use sardines as the source. So skip the pill and eat some real fish! Cod liver oil has traditionally been considered a whole food way to get the benefits of fish oil as well. Our family has taken this in the past, but it has been the subject of some recent controversy as well.
It is also important to pay attention to Omega-3 and Omega-6 ratios in the body. Instead of only focusing on consuming more Omega-3, we should pay attention to the amount of Omega-6 we consume and work to get those numbers to a healthy ratio.
At the end of the day, more fish, more veggies, and less processed foods (with vegetable oils) are the way to go!
Do you take supplemental Omega-3s? Have they helped you? Share below!
Discussion (154 Comments)
Thank you for this Katie, I appreciate the work you do in educating the rest of us. This is my first time commenting here on your blog, but I’ve been a follower for awhile now, and have shared many posts of yours with friends and family. I’ve also started to look into various things myself, like the circadian effects, cortizol, and of course, anything else I can find that is remotely connected to Hashimoto’s.
I’m looking forward to the continued content! And more about the journey you’re currently on, to heal and support your thyroid and body.
*I don’t know if this is going to post multiple times, I’m having connection issues this evening!
Do you have a recommendation for kids?
Yes I’d love a recommendation for kids! Trying to boost my nine year old son’s immune system because of his allergies.
How is it filtered? I’ve been taking Nordic Naturals because they seem to be one of the safest and purist ones out there. What are the levels of mercury, dioxins, and lead in the one that you recommend?
Katie - Wellness Mama
There is a video on that page that explains all of that.
Thank you so much for the information on Omega 3’s. I knew of their importance and the fact that the diets of most of us contain an excess ratio of Omega 6’s to 3’s, but did not know which company’s product to trust as all advertise theirs to be the best.
I had not heard of RealDose Nutrition, but am grateful for your research and will be ordering from them with confidence.
I love your site! I recently started taking fermented cod liver /butter oil blend but after reading your post on omega 3 TG I’m confused on which I should be taking. I’m breast feeding my four month old and would love to hear about what you think are the essential supplements to take while on a budget. I can’t afford to take both cod oil and omega 3TG… Which should I take?
Katie - Wellness Mama
I take both, but in the summer, I’d probably stick to RealDose and make sure to get Vitamin D from the sun and Vitamin A from liver if I had to choose 🙂
How much of the fish oil do u take if u are already taking fclo?
Katie - Wellness Mama
3 capsules a day
Thank you so much for always providing us with great research and sources. I love your website and always learn something new. You have helped me make better and healthier choices for my family. I want to if have any recommendation for kids on the fish oil. Thank you
My kids enjoy a plant based Omega blend that you can either swallow or chew.
I have been taking Nordic Naturals and am planning to try the Carlson product which is very similar but less expensive. Nordic Naturals is a liquid with a slight lemon flavor. I started taking it in smoothies but honestly prefer to just take a straight shot of it followed by something to eat. It has NO fishy taste or after taste…none!! Bottle recommends 1 tsp, daily, which contains 825 EPA and 550 DHA. However, I take 3x that….1 TBSP. I began after my brother-in-law was told to take it at a dose of TWO TBSP. per day as part of a regimine to reduce his back pain. My TBSP. dose contains 2475 EPA and 1650 DHA which is way more than one can easily obtain with capsules. My brother-in-law has seen tremendous benefit; I’ve only been ‘at it’ for a couple of weeks, but feel it is already benefiting me as well 🙂 Thanks for bringing up the importance of the Omega 3’s 🙂
Just wanted to mention I just read a study on LabDoor that liquid (non-softgel) fish oils are much less potent in reality than what is stated on the bottle. Sorry, but it thought you should know! We have to look out for each other 🙂
What are your thoughts on EPA to DHA ratios? Chris Kresser recommends a few brands and I take the most affordable of those, the Jarrow Formulas Max DHA. There is the same amount of total Omega 3s in 4 of these as there are in 3 of the product you suggest, but there is a much higher DHA ratio in the Jarrow formula. Do we want more EPA or DHA or does it matter?
Thank you for ALL your information!!!
Katie - Wellness Mama
Both DHA and EPA are important and from my research, the RealDose Omega-3 has it in the correct ratio. I’d also make sure that any you take is in the natural triglyceride form so it can be absorbed.
How many cans of the sardines a week would one eat, two? Would that be enough and better than taking a pill.. (even Nordic naturals?)
It’s going to depend on the individual…
Katie, thank you very much for sharing your story at thyroid sessions.
i have same development, being over-active at 20´ and comming to bottom with lots of depression and fatique, barely being able care for kids. and even though on quite good diet, traditional chinese medicine, etc i can not get out of it. i was diagnosed w hashimotos a few years ago, but i had no idea, how i could help myself and that this is the reason why i feel this down all the time.
i am now on AIP for one week and already feeling improvement, i hope to be well again.
you have mentioned some other supplement you are taking to balance T3-T4, but because i am foreigner, i didnt understand what it was exactly, could you please let me know what do you take?
best regards and lots of love to you and your big family,
Katie - Wellness Mama
I take a product called Wp-Throid that was prescribed by my doctor. Hope you feel better soon!
Oh no, now I’m confused! Do I take this or FCLO? I’ve been meaning to order some fish oil as I taper my meds for depression and bipolar.
Katie - Wellness Mama
I take both, but if I had to choose, I’d take this in the summer and just make sure to get a lot of natural Vitamin D