In Part 2 of our series on increasing your Omega-3 Index, we tackle omega-3 supplements. Just as with food, your decisions regarding whether or which supplements to take is entirely based on what works for you. To paraphrase from our last blog, we believe that everyone has a different definition of what constitutes the “best way” to increase their Omega-3 Index, depending on their preferences and values, i.e. what dietary source is the most potent, most natural, most sustainable, cheapest, purest, etc.? In this month’s blogs, we will present data (and our thoughts) on the many ways to raise your Omega-3 Index using supplements. We at OmegaQuant have always been agnostic when it comes to which omega-3 dietary supplements to use, and we try to let the data speak for itself. People can then choose what works for them. Here are some considerations:
Supplements are NEVER a substitute for a healthy diet.
Supplements are supposed to “supplement” or “add to” a healthy diet, not act as an excuse to eat poorly and be saved by taking supplements. Consuming fish regularly is the preferred method of increasing blood omega-3 levels. This is because fish are also an excellent source of protein and other micronutrients, like selenium and iodine, and it can can replace a less healthy meat or protein option in your meal – a double win! In addition, the most consistent evidence that omega-3s are beneficial for health is from populations that consume fish frequently (and have high blood omega-3 levels), whereas the supplementation studies are less convincing. In short, aim to have 2 servings of fish (preferably “oily” i.e. high omega-3 fish) per week regardless of your supplementation regimen.
The most important part of the supplement is the amount of EPA+DHA per pill.
There are so many options for omega-3 supplements available in the US and worldwide. In our opinion, the most important aspect to consider when choosing a supplement is the dose of EPA+DHA per capsule. Below we compare the front and back labels of 2 widely available fish oil supplements.
Why is there a discrepancy between the amount of “fish oil” and “omega-3”? Because “fish oil” is not synonymous with “omega-3s” EPA+DHA. Fish oil is rich in omega-3 EPA+DHA but also contains other fatty acids. A supplement with a higher ratio of “omega-3” to “fish oil” is a more concentrated source of EPA+DHA, meaning you need to take fewer pills to get the same amount of EPA+DHA. But how can you know for sure? Let’s look at the back panel:
Notice the serving size. 2 capsules for Fish Oil #1 vs. 1 capsule for Fish Oil #2. If you don’t like taking lots of pills, it’s best to try to find a highly concentrated supplement so can take fewer pills.
Look for EPA+DHA levels specifically. Fish Oil #2 provides the levels of EPA and DHA separately, so you know exactly what you are taking. Fish oil #1 does not provide EPA and DHA levels separately but it does show the amount of EPA+DHA per serving (2 pills). The amount of “Fish Oil Concentrate” or “Total Omega-3 Fatty Acids” is not important; the EPA+DHA level is.
980 mg EPA+DHA in 1 pill vs. 500 mg EPA+DHA in 2 pills? Fish Oil #2 is the clear winner for potency. In addition to picking the most potent pill, you may check your Omega-3 Index before and after starting supplementation to see if you are taking enough to reach your goals. We have an Omega-3 Index Calculator to help you determine how much EPA+DHA you should take to reach a protective Omega-3 Index level.
Also, consider cost. Another way to determine your ideal supplement is to consider how much you pay per gram of EPA+DHA. Fish Oil #1 costs ~$7.50 per bottle (online as of 4/4/17), which comes to 17¢ per gram of EPA+DHA. Fish Oil #2 costs ~$16 (online as of 4/4/17), which is essentially 12¢ per 1 gram EPA+DHA. Fish Oil #2 is a more economical product and a smarter buy!
Omega-3 or fish oil capsules don’t work if you don’t take them.
This may be obvious but it’s very important. If you buy supplements but only take them intermittently, do not expect large changes in your omega-3 blood levels. Blood levels, particularly the Omega-3 Index, reflect long-term intake of about 3-4 months. Failure to take fish oil capsules is also a major issue in omega-3 research; that is, if people assigned to take fish oil capsules in a research study do not do so (this is called being “non-compliant”), it’s no wonder the fish oil “doesn’t work.” This is not rocket science! This is why one of our main goals at OmegaQuant is to work with researchers to measure omega-3 status in large clinical trials as a way of measuring “compliance” with the assigned treatment.
What kind of supplement is the best? Krill, salmon, fish, prescription, vegan…???
There is a lot of information and confusion in this area, so to make it simple, the best supplement is the one that 1) you will take and 2) that fits in your budget. The most concentrated supplement may be very expensive whereas the cheapest supplement may only provide 300 mg EPA+DHA per day. On the other hand, some concentrates come in pills that are prohibitively large (for some people). If you won’t/can’t take the larger pills, the high dose of omega-3 inside won’t do you any good at all. Find the balance that works for you- figure out the amount of EPA+DHA per pill, the cost, the pill size and then make your decision based on that.
Omega-3 supplements are safe and generally have few side effects.
Omega-3s are generally recognized as safe up to 3000 mg EPA+DHA/day by the FDA. However, nutritional supplements in the US are not regulated by the FDA, so you have to trust the supplement maker that the dose and purity of the capsule are what they say they are. A recent research study from Australia tested available fish oils on the market for omega-3 and oxidation levels. They found that all 10 brands that they tested with standardized methods had omega-3 levels at or exceeding the advertised amount and all were below the acceptable levels of oxidation. So that’s good news.
There are few documented side effects from taking fish oil from research studies. The main complaints are gastrointestinal issues like fishy taste, “fish burps” (although many supplements are “enterically coated” to reduce this), diarrhea and nausea. Taking omega-3 supplements with foods (as opposed to on an empty stomach) should improve absorption and reduce these side effects. Other reported concerns are excessive bleeding (this has been debunked), fish allergies (usually a response to fish protein, not fatty acids, so is not a concern), glycemic control (research has not confirmed this claim), and increasing LDL-cholesterol (a small increase accompanies the decrease in triglycerides). Fish oil supplements from reputable companies are free from organic pollutants and methyl mercury. In sum, the risk-benefit ratio for taking omega-3 supplements is very favorable on the benefit side.
Bottom line: In choosing a supplement, read the label and get the highest EPA+DHA per pill as possible that fits into your budget and you can swallow. Then, take your supplement regularly, continue to eat fish, and get your Omega-3 Index tested to find out if you are reaching your goals.