Omega-3 Fatty Acids

TL;DR

Omega-3 fatty acids are essential fats that primarily lower blood triglycerides and reduce inflammation by acting as key components of cell membranes. The evidence for lowering triglycerides is strong, with a typical daily dose of 500-1000 mg of combined EPA and DHA for general heart health. For best absorption, choose a triglyceride (TG) or re-esterified triglyceride (rTG) form and take it with a meal containing fat.

Why I'm Taking It

Generally considered one of the best and most proven nutritional supplements full stop
Benefits include cardiovascular health support, heart health and inflammation reduction
- New studies show link to dementia risk reduction
Basically no reason to not supplement with Omega-3 unless you're an Arctic native, eating fresh fish 3 times daily

Background

Omega-3s are a class of polyunsaturated fatty acids. The three main types are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is an essential fatty acid, meaning the body cannot produce it and it must be obtained from the diet. ALA is found in plant sources like flaxseeds, walnuts, and canola oil. EPA and DHA are found primarily in marine sources like fatty fish (salmon, mackerel, sardines), krill, and algae. While the body can convert a small amount of ALA into EPA and DHA, the process is very inefficient. Omega-3s are critical components of cell membranes and play a vital role in regulating inflammation, blood clotting, heart rhythm, and brain function. DHA is particularly concentrated in the brain and retina.

Recommended Form of the Supplement

Fish Oil (Triglyceride or Re-esterified Triglyceride Form): This is the most common form. The natural triglyceride (TG) or re-esterified triglyceride (rTG) forms are generally considered more bioavailable than the ethyl ester form. Provides both EPA and DHA.
Fish Oil (Ethyl Ester Form): A more processed and concentrated form, often found in cheaper supplements. Bioavailability is lower than the TG/rTG form but can be improved when taken with a fatty meal.
Krill Oil (Phospholipid Form): Sourced from krill, this form provides EPA and DHA bound to phospholipids, which may enhance absorption. It also naturally contains the antioxidant astaxanthin.
Algal Oil: A vegetarian and vegan source of EPA and DHA derived directly from marine algae. This is an excellent option for those who do not consume fish.
Flaxseed Oil: A primary source of plant-based ALA. While beneficial, it is not an efficient source of EPA or DHA due to the body's poor conversion rate.

Expected Effects

Cardiovascular Support: May significantly lower blood triglyceride levels. Can help maintain normal blood pressure and support overall heart function.
Anti-inflammatory Effects: Helps to resolve inflammation, which may benefit conditions like rheumatoid arthritis.
Brain Health & Development: DHA is a key structural component of the brain and is crucial for infant brain development and maintaining cognitive function in adults.
Eye Health: High concentrations of DHA in the retina support normal vision and may reduce the risk of age-related macular degeneration (AMD).
Mood Support: Some studies suggest a potential role in alleviating symptoms of depression.

Dosage Recommendations

General Health: A combined daily dose of 250-500 mg of EPA + DHA is commonly recommended for healthy adults. This can often be met by eating fatty fish twice a week.
Specific Conditions (under medical guidance):
- High Triglycerides: Doses up to 4 grams (4000 mg) of EPA + DHA per day.
- Heart Health Support: Approximately 1 gram (1000 mg) of EPA + DHA per day.
Tolerable Upper Intake Level (UL): Health authorities like the FDA and EFSA suggest that supplemental EPA + DHA is safe for most adults at doses up to 5 grams (5000 mg) per day.
Timing: Always take with a meal containing fat to maximize absorption and minimize gastrointestinal side effects like fishy burps.

My Current Dosage & Timing

Dosage: 900mg EPA & DHA Form: Triglyceride Fish Oil Timing: 1 capsule with lunch

Usage Notes, Best Practices & Important Considerations

Check for Purity: Choose supplements that are third-party tested for purity to ensure they are free from heavy metals (like mercury), PCBs, and dioxins. Reputable brands often provide a Certificate of Analysis (COA).
Assess for Rancidity: Omega-3 oils are prone to oxidation (rancidity), which negates their benefits and can be harmful. Avoid supplements that have a strong fishy smell or taste. Break a capsule open to check before consuming a new bottle.
Proper Storage: Store supplements in a cool, dark place away from direct sunlight and oxygen. Refrigerating liquid fish oil after opening is recommended to preserve freshness.
Monitoring: For those targeting specific health outcomes, an Omega-3 Index test can measure the percentage of EPA and DHA in red blood cell membranes. A level of 8-12% is considered optimal for cardiovascular protection.
Gastrointestinal Side Effects: If you experience indigestion or fishy burps, try a different form (e.g., krill oil), an enteric-coated product, or freezing the capsules before taking them.

Contraindications/Interactions

Bleeding Disorders: Use with caution in individuals with bleeding disorders, as high doses may inhibit blood clotting. It's often recommended to stop taking omega-3s 1-2 weeks before scheduled surgery.
Fish/Shellfish Allergy: Individuals with a known allergy to fish or shellfish should use fish- or krill-derived supplements with caution and consider algal oil as an alternative.
Medication Interactions:
- Anticoagulants/Antiplatelets: High doses of omega-3s may increase the risk of bleeding when taken with drugs like Warfarin, Clopidogrel, or Aspirin. While the clinical risk at moderate doses appears low, it's crucial to discuss with a healthcare provider and monitor closely.
- Blood Pressure Medications: Omega-3s can have a mild blood pressure-lowering effect, which could be additive when combined with antihypertensive drugs.
- Orlistat: This weight-loss drug can reduce the absorption of fat-soluble nutrients, including omega-3 fatty acids. Take them at least 2 hours apart.

Reputability/Trustworthiness of Studies

The evidence for omega-3 fatty acids is among the most robust in the supplement world for specific outcomes.

Strong: The evidence for lowering blood triglycerides is very strong and is an FDA-approved use for prescription omega-3s. The benefits for cardiovascular health are well-supported by major health organizations like the American Heart Association, particularly for secondary prevention in those with existing heart disease.
Moderate to Strong: Evidence for supporting infant brain and eye development (DHA), and for reducing inflammation, is well-established.
Moderate but Emerging: The evidence for mood disorders (like depression) and cognitive function in adults is promising but less conclusive than for cardiovascular outcomes. Examine.com rates the evidence for lowering triglycerides as high.