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We’re now several years into the fish oil revolution, far enough for most everyone to have heard of it and many to be taking it. Let’s take a couple of pages to talk about why omega-3s are good for us, and since there was a fish-oil purity lawsuit filed that gave us something to talk about last week, we’ll do an introduction to fish oil processing.

Omega-3 is an essential fat, called that because the human body can’t make it. There are two types of omega-3s, a plant-based oil from flax seed, walnuts or canola that yields ALA (alpha linolenic acid), which converts to EPA and DHA in the body, and fish-based oils that consist primarily of EPA and DHA and require no conversion.

EPA and DHA are two fatty acids vital for good cellular function. High levels of EPA and DHA help with immune system response, are important in lowering inflammation, and play a role in all biological processes. The benefits of omega-3s are well documented by about 8,000 research studies—not exaggerating here, you can look ‘em up if you want to. The bottom line you’re going to find is the combination of EPA and DHA is thought to—

• Strengthen the heart, reducing risk of heart disease and stroke and lowering blood pressure
• Manage blood chemistry, such as cholesterol, triglycerides and blood sugar
• Be a factor to skin health, from dryness to eczema
• Contribute to eye health, better vision, reducing the risk of macular degeneration, and better hand-eye coordination
• Fortify the joints and bones
• Play a role in brain health, including possibly working as an anti-depressant, providing mood elevation and increased sustained attention
• Assist in bringing down inflammation
• Ease or completely relieve allergy symptoms
• Provide better energy levels

While omega-3 oil may be best known for its ability to normalize lipids for cardiovascular health, the inflammation relief could well be the kicker, because systemic inflammation may cause many of the troublesome health issues you can think of, from joint pain to heart disease, Alzheimer’s and cancers.

The best source for these omegas is oily, cold-water fish like herring, tuna, sardines, anchovies, salmon and cod. But instead of eating herring, our Western diet is high in Omega-6s and low in Omega-3s. Because these basically metabolize the same, the higher 6s overpower the 3s, which compromises tissue function, increases inflammation and swelling and speeds up the cellular aging process.

Since we’re 100% cells, cellular aging is bad juju.

EPA and DHA

EPA is Eicosapentaenoic Acid, good for heart health (lipids, smooth blood vessels, heart muscle function), joint flexibility and decreased joint swelling, assists in immune system response and helps maintain metabolic health.

DHA is docosahexaenoic acid; it improves mood, helps with the nervous system, enhances memory and clear thinking, is good for eye health and contributes to infant health during pregnancy.

As important as all this is, many people are completely unaware of the value of fish oil; others are confused between the omega oils, and many don’t care for fish as a food. When you put all the factors together, it’s easy to see how we got so deficient—the sales material I got from one of our suppliers, Nordic Naturals, quotes an estimation of 80% of Americans being deficient in Omega-3s.

The American Heart Association (AHA) recommends that people with no history of heart disease eat oily fish at least twice a week. Don’t do that? Supplement.

For those with documented heart disease, the AHA suggests one gram of EPA plus DHA daily. Those who need to lower their triglycerides should use two to four grams of EPA, plus DHA, again according to the AHA. The AHA recommends even more for those with high triglycerides; for those people the Association suggests 2-4 grams of the combined EPA/DHA, and to make it easier to get, there’s a prescription fish oil you can get from a doctor if you haven’t been able to reduce your triglycerides on your own.

As a comparison between foods and supplements, the values of EPA and DHA in two Nordic Naturals fish oil softgels is equivalent to a half-can of sardines, 44 one-gram flaxseed softgels or a 10-ounce bag of flaxseed. In terms of comparison, well… it’s clear there is none.

Quality vs Quantity

As long as we know we should be getting fish oil, let’s talk about quality versus finances and see if we can figure out how to proceed.

Consumer Reports did a review of fish oil in 2008 and reported in all of the 52 products they tested, there was no detectable mercury. All passed contamination limits for lead, dioxins and PCBs, both the cheaper and the more expensive brands. What they did find was a difference in the amount of EPA and DHA concentration per serving; non-concentrated fish oil contains approximately 20-30% of EPA and DHA, whereas a highly purified oil will get to as high as 85%.

This is where you have to do a little homework: When using one product you may be able to get all you need from two or four capsules, but with another you may have to take a dozen or more to get the same quantity. Incidentally, this is product-specific, not brand specific; some manufacturers carry multiple levels of concentration, resulting in multiple price breaks within the same brand.

Higher Cost Oils

As you might expect, there’s a bit more to the story. Fish oil is sensitive to oxidation, very sensitive, and will easily turn rancid. The tendency toward repeats (the polite way of calling out fish burps) is sometimes an indication of cheaper oil, possibly even rancid oil, and free radicals in your supplement intake is going to reverse all the good the omega intake might have done. However, don’t assume rancidity just because you taste fish after taking your oil; it could be that you need to get some food in your stomach first, and, in fact, that’s not a bad idea from an EPA/DHA supplemental standpoint so you don’t use the oils primarily for energy.

What you may get in a higher cost oil—

• Smaller fish that have short reproductive cycles to minimize the metals
• Lower heat, oxygen-free processing
• Removal of potential impurities such as minerals and trace elements
• Molecular distillation, selecting EPA and DHA fatty acids at the molecular level and binding them to alcohol to allow for a greater EPA/DHA concentration
• Enzymatic and CO2 processing
• Reattaching the fatty acids to glycerol to form a natural triglyceride

That last one is an important one, and it’s one we’re going to be hearing out more over the next couple of years as more research gets published. There are two forms of fish oil, one a synthetic ethyl ester and the other a natural triglyceride. The EPA and DHA we want are in the fish triglycerides, and after the manufacturers extract the fatty acids, these have to be relinked, either with enzymes to create a new triglyceride or with ethanol, the cheaper option that creates the ethyl ester form of omega-3 oils.

Apparently, the synthetic ethyl ester form is more unstable, and breaks down faster during storage. Additionally, once ingested, the body doesn’t convert the ethyl ester form back to triglycerides, and it’s therefore more susceptible to oxidation—the free radical damage issue we’re all aware of but few of us understand. These factors would make the triglyceride form both more stable during and after processing, and better absorbed after ingestion. This potential better absorption may be the reason some people notice no response from fish oil until they switch to a more expensive brand.

The difference between the two forms is the subject of ongoing research, but for the curious, at the end of this I’ll add a list of references I got from Nordic Naturals, a high-quality oil manufacturer, one of our suppliers.

Fish Oil FinancesThe Nordic Naturals ProOmega line we carry includes additional processing steps to increase the concentration of EPA and DHA to about twice the average. Let’s compare that with the Now Foods brand we also trust and carry. The two Nordic products we have are the ProOmega-D in a lemon-flavored liquid oil and in 120-count soft gels. Both also have added Vitamin D, enough to cover most people’s daily requirements.

Now Foods, $11.95, 200 soft gels per bottle, 2 gels represents 360 mg EPA, 240 mg DHA

Nordic Naturals, $39.95 for 120 soft gels, 2 soft gels yield 650 mg EPA, 450 mg DHA, 1000 IU Vitamin D

Nordic Naturals, eight ounces (48 teaspoons) for $59.95, 1 tsp liquid oil yields 1626 mg EPA, 1126 mg DHA, 1000 IU Vitamin D

Because I’m math-challenged, I went with the liquid oil as the standard. One teaspoon of the Nordic Naturals ProOmega (1626 mg EPA, 1126 mg DHA) is equivalent to 5 Nordic soft gels (1625 EPA/1125 DHA) or 9 Now Foods soft gels (1620 EPA/1090 DHA).

The Nordic liquid oil serves up 48 doses at $59.95; the Nordic capsules equals 24 servings per bottle at $39.95, and the Now Foods offers 22.2 9-cap doses for $11.95.

From a financial standpoint, the Now Foods capsules are the clear winner at 54 cents per dose; the Nordic liquid oil comes in second at $1.25 and the Nordic capsules fall behind at $1.66.

Deciding on Quality

Aside from the finances, there are four main things to consider.

1. Do the repeating fish burps cause you to skip your fish oil supplement?
2. Do you decide to skip it when you look at that huge handful of pills every night?
3. Have you heard of miraculous benefits, yet after a couple months of faithful supplementing you felt nothing? Some people report a response after either increasing the dosage by a big factor, or by switching to a higher quality oil.
4. After you review the material on the triglyceride versus the ethyl ester processing, are you convinced the triglycerides are better?

A yes answer to any of the above would suggest a trial run with a top-quality fish oil.

Other than that, if you’re having great success with a cheaper brand, the math is pretty compelling. I wouldn’t have guessed there was that much difference without going through the calculations.

To hear what others in the forum are discovering with their fish oil experimentation or to ask questions, click on over to the fish oil thread in the forum, here.

For those looking for the triglyceride vs ethyl ester form research data supplied by Nordic Naturals, here ya go:

1 Lawson LD, Hughes BG. Human absorption of fish oil fatty acids as triacylglycerols, free acids, or ethyl esters. Biochem Biophys Res Commun 1988;152:328–335.
2 Lawson LD, Hughes BG. Absorption of eicosapentaenoic acid and docosahexaenoic acid from fish oil triacylglycerols or fish oil ethyl esters co-ingested with a high-fat meal. Biochem Biophys Research Comm 1988;156:960–963.
3 el Boustani S, Colette C, Monnier L, et al. Enteral absorption in man of eicosapentaenoic acid in different chemical forms. Lipids 1987;22:711–714.
4 Beckermann B, Beneke M, Seitz I. Comparative bioavailability of eicosapentaenoic acid and docasahexaenoic acid from triglycerides, free fatty acids and ethyl esters in volunteers. Arzneimittelforschung 1990;40:700–704. [German]
5 Visioli F, Rise P, Barassi MC, et al. Dietary intake of fish vs. formulations leads to higher plasma concentrations of n-3 fatty acids. Lipids 2003;38:415–418.
6 Hong DD, Takahashi Y, Kushiro M, et al. Divergent effects of eicosapentaenoic and docosahexaenoic acid ethyl esters, and fish oil on hepatic fatty acid oxidation in the rat. Biochim Biophys Acta 2003;1635:29–36.
7 Nordoy A, Barstad L, Connor WE, et al. Absorption of the n-3 eicosapentaenoic and docosahexaenoic acids as ethyl esters and triglycerides by humans. Am J Clin Nutr 1991;53:1185–1190.
8 Krokan HE, Bjerve KS, Mork E. The enteral bioavailability of eicosapentaenoic acid and docosahexaenoic acid is as good from ethyl esters as from glyceryl esters in spite of lower hydrolytic rates by pancreatic lipase in vitro. Biochim Biophys Acta 1993;1168:59–67.