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.
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!