Fish oil based omega-3s provide anti-inflammatory, cognitive and cardiovascular support.
Fish as a food has been a staple in various cultures and societies for thousands of years. In fact, a hypothesis exists that attributes human brain evolution and cognition expansion to the consumption of fish millions of years ago. This hypothesis is supported by the unique biochemical components that fish contains and its role in human health.
If this wasn't already known, humans are classified as omnivores, meaning they have developed the adaptive ability to consume both plant and animal based foods. This classification is based on a number of factors, including anatomical and digestive features alongside dietary preferences observed over thousands of years. For example, humans have incisor teeth that are used to cut and molar teeth used to grind both plant and animal based foods, which are typically found in omnivore species. Another example is the human digestive tract length falling in between both carnivores (short) and herbivores (long) indicating adaptive evolution to consume a variety of foods. If that wasn't enough evidence, humans also contain enzymes that break down both plant based carbohydrates and animal based proteins and fats. This classification is further supported by the historic observation and evidence of humans consuming diets based on certain cultural practices and the need to adapt to various environmental conditions. As a result, the evolutionary ability to consume a wide variety of foods has allowed the human species to survive, adapt and succeed in various geographical regions of the world.
Alongside fish being a complete source of protein containing all nine essential amino acids for humans, omega-3 fatty acids are also an important and a highly researched component of fish. Below is a simplified diagram of how omega-3 fatty acids are metabolized in human cells once consumed.
Dietary origins and the metabolic process of omega-6 and omega-3 polyunsaturated fatty acids result in the production of pro-inflammatory and anti-inflammatory substances, respectively.
Image Source:
Omega-3, -6 and -9 fatty acids each have distinct chemical structures, health benefits and are found in a variety of dietary sources. Some of the most common and most researched include ALA, EPA, DHA, LA, AA and OA, respectively. ALA as an omega-3 is found in plant sources like flaxseeds, chia seeds, walnuts, and leafy green vegetables. EPA and DHA as omega-3s are found in fatty fish such as salmon, mackerel, and sardines. LA and AA as omega-6s are found in meat, poultry, nuts, seeds, grains, processed foods, and vegetable oils such as corn oil, soybean oil, and sunflower oil. OA as an omega-9 is abundant in olive oil, avocado oil, and nuts such as almonds and peanuts.
Omega-3 fatty acids are essential for human health and associated with numerous health benefits, including cardiovascular health, brain function, and reducing inflammation. While omega-6 fatty acids are essential for health as well, excessive intake relative to omega-3 fatty acids may contribute to inflammation and certain chronic diseases if not balanced properly. And lastly, omega-9 fatty acids are not classified as essential because the body can produce them from other fats. However, omega-9s still offer health benefits, including supporting heart health and reducing inflammation.
Fish Oil (Omega-3) Research and Dosages
Prior to starting anything new, always consult your naturopathic or medical doctor first to ensure it is right for you. This information is not medical advice and is not intended to replace any medical treatment plan already set by your healthcare providers.
While dietary intake of fish varies due to a number of factors including culture, geographical region, availability, accessibility, awareness of health benefits, cost, affordability, preference and dietary habit, it has been noted that not everyone in North America consumes enough fish to meet recommended intake levels. Public health initiatives and educational campaigns aimed at promoting the benefits of fish consumption and providing information on sustainable fishing practices may help increase fish consumption among populations in North America.
As such, the incorporation of fish oil supplements (omega-3s) is a beneficial way of meeting those dietary needs, optimizing health and/or supporting various health conditions. Fish oil decreases triglyceride levels by reducing the synthesis and release of triglyceride-rich lipoproteins by the liver. Additionally, it may enhance triglyceride clearance by increasing the activity of the lipoprotein lipase enzyme, assisting with lowering cholesterol levels. EPA and DHA, the components of fish oil, are primarily integrated into the phospholipid layer of cell membranes in platelets, neutrophils, and red blood cells. EPA plays a significant role in stabilizing cell membranes and inhibiting lipid oxidation, leading to the regulation of vascular tone, improved cell signaling, and reduced inflammation. This translates into reducing blood pressure, in particular for those with hypertension as well. It has also been noted to help with symptoms of depression and provide some relief to those with auto-immune conditions like SLE and Rheumatoid Arthritis.
Fish oil (omega-3) research has expanded into health optimization and many other chronic and acute conditions including, but not limited to diabetes, various cancers, immune health, HIV, ADHD, cognitive improvement, cognitive decline/impairment, bipolar disorder, schizophrenia, Alzheimer's, anxiety, autism, peripartum depression, coronary artery disease, muscle gain, general athletic performance, aerobic/anaerobic exercise performance, muscle recovery, obesity, weight loss, PMS, PCOS, endometriosis, menopause, pregnancy, delivery health, infertility, asthma, COPD, chronic kidney disease, end-stage renal disease, NAFLD, macular degeneration, skin health, gout, migraines, myalgic encephalitis, osteoarthritis, stroke, cardiomyopathy, digestive health, and insomnia.
Fish oil supplement doses vary based on the intended purpose. For general cardiovascular health, a minimum of 250 mg of combined EPA and DHA is recommended, which can be obtained through consuming 1g of fish per day as recommended by the American Heart Association. These recommendations account for the combined total of EPA and DHA, which should be sourced from a combination of dietary sources and supplements. Higher dietary intake of EPA and DHA reduces the need for supplementation. Pregnant women are advised to increase their DHA intake by at least 200 mg per day, provided there is no risk of mercury exposure.
When it comes to omega-3 supplements, they generally fall into higher dosing ranges due to various research studies. For example, for general cardiovascular health it has been demonstrated that 250mg to 4000mg per day combined EPA and DHA is beneficial. For cholesterol (lowering TG and raising HDL-C) benefits, no less than 2000mg to a maximum of 4000mg per day of combined EPA and DHA, with increasing dosing resulting in lower TG and higher HDL-C, has been demonstrated as beneficial. For adult mood and behaviour, a 2:1 ratio or greater of EPA to DHA, with a minimum 1000mg EPA per day has been demonstrated as beneficial. For childhood mood and behaviour, a ratio of 2:1 or greater of EPA to DHA, with a minimum of 500mg to 600mg of EPA per day has been demonstrated to be beneficial. For inflammation (joint pain, IBD, asthma, SLE etc.) 2000mg to 4000mg of combined EPA and DHA per day has been demonstrated to be beneficial. In pregnancy, a minimum of 300mg DHA per day with a ratio of 1.5-2:1 EPA to DHA has been demonstrated to be beneficial. And lastly, 900mg per day of combined EPA to DHA for general health promotion and disease prevention has been demonstrated to be beneficial. It is always recommended to follow the labeled instructions for that specific fish oil supplement, which is generally in alignment with the relevant research.
Fish oils come in liquid form and must be refrigerated when opened with various flavours or in capsular form, which do not require refrigeration. The dark colour of the bottles help prevent oxidation due to sun exposure. Fish oil can be consumed throughout the day as well. Taking it with meals can help minimize the unpleasant taste known as "fish burp."
Are there any concerns with fish oil?
It's important to note that some fish oil supplements are not closely regulated, and may contain impurities such as contaminants, oxidized fatty acids, and saturated fats, which can diminish their effectiveness. In Canada, an NPN (Natural Product Number) is a unique identifier issued by Health Canada's Natural and Non-prescription Health Products Directorate (NNHPD) for natural health products (NHPs). NHPs include vitamins, minerals, herbal remedies, homeopathic medicines, traditional medicines like traditional Chinese medicine, probiotics, and other products like amino acids and essential fatty acids. Obtaining an NPN indicates that the product has been assessed by Health Canada and deemed safe, effective, and of high quality based on evidence of its medicinal or therapeutic claims, as well as its manufacturing processes. It's a regulatory requirement for natural health products to have an NPN before they can be legally sold in Canada. Consumers can look for the NPN on product labels to ensure they are purchasing authorized and regulated health products.
Fish oil supplements are generally considered safe and well-tolerated, including concomitantly with a number of pharmaceuticals, but some may experience stomach discomfort, fishy breath and burping, heartburn, nausea, easy bruising, and diarrhea when consumed. Additionally, certain formulations have been associated with elevated levels of LDL cholesterol.
Despite its antiplatelet/blood thinning effects, most clinical studies have not shown an increased risk of bleeding associated with fish oil supplementation. It is recommended to stop taking fish oils at least 7 days prior to any form of surgery and to be mindful of possible interactions with blood thinning medications.
If you are wondering if fish oils are right for you or have more questions, book an appointment with Dr. William Meditskos, HBSc, ND to find out more!
References:
Aiello, L. C., & Wheeler, P. (1995). The expensive-tissue hypothesis: The brain and the digestive system in human and primate evolution. Current Anthropology, 36(2), 199-221.
American Heart Association. (2003). Arteriosclerosis, Thrombosis, and Vascular Biology, 23(1), 151-152.
American Heart Association Nutrition Committee, Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., ... & Horn, L. V. (2000). Circulation, 102, 2284-99.
American Heart Association Nutrition Committee, Lichtenstein, A. H., Appel, L. J., Brands, M., Carnethon, M., Daniels, S., ... & Horn, L. V. (2002). Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation, 106(25), 2747-2757.
Ann C Skulas-Ray, Peter W F Wilson, William S Harris, Eliot A Brinton, Penny M Kris-Etherton, Chesney K Richter, Terry A Jacobson, Mary B Engler, Michael Miller, Jennifer G Robinson, Conrad B Blum, Delfin Rodriguez-Leyva, Sarah D de Ferranti, Francine K Welty; American Heart Association Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; and Council on Clinical Cardiology (2019). Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association. Circulation.
Appleton, K. M., Voyias, P. D., Sallis, H. M., Dawson, S., Ness, A. R., Churchill, R., & Perry, R. (2021, November 24). Omega-3 fatty acids for depression in adults. Cochrane Database of Systematic Reviews.
Bantle, J. P., Wylie-Rosett, J., Albright, A. L., Apovian, C. M., Clark, N. G., Franz, M. J., ... & Wheeler, M. L. (2008). Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care, 31(Supplement 1), S61-S78.
Bjermo, H., Iggman, D., Kullberg, J., Dahlman, I., Johansson, L., Persson, L., ... & Rudling, M. (2012). Effects of n-6 PUFAs compared with SFAs on liver fat, lipoproteins, and inflammation in abdominal obesity: a randomized controlled trial. The American Journal of Clinical Nutrition, 95(5), 1003-1012.
Breast Cancer Research. (2024). Retrieved from https://breast-cancer-research.biomedcentral.com
Brosolo G, Da Porto A, Marcante S, Picci A, Capilupi F, Capilupi P, Bertin N, Vivarelli C, Bulfone L, Vacca A, Catena C, Sechi LA Omega-3 Fatty Acids in Arterial Hypertension: Is There Any Good News?Int J Mol Sci.(2023-May-30)
Calder, P. C. (2015). Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochimica et Biophysica Acta (BBA)-Molecular and Cell Biology of Lipids, 1851(4), 469-484.
Calò, L., Bianconi, L., Colivicchi, F., Lamberti, F., Loricchio, M. L., de Ruvo, E., ... & Di Mario, C. (2005). N-3 Fatty acids for the prevention of atrial fibrillation after coronary artery bypass surgery: A randomized, controlled trial. Journal of the American College of Cardiology, 45(10), 1723-1728.
Christos F Kelaiditis, E Leigh Gibson, Simon C Dyall (2023 May). Effects of long-chain omega-3 polyunsaturated fatty acids on reducing anxiety and/or depression in adults; A systematic review and meta-analysis of randomised controlled trial. Prostaglandins Leukot Essent Fatty Acids.
Cordain, L., Miller, J. B., Eaton, S. B., Mann, N., Holt, S. H., & Speth, J. D. (2000). Plant-animal subsistence ratios and macronutrient energy estimations in worldwide hunter-gatherer diets. The American Journal of Clinical Nutrition, 71(3), 682-692.
Cunnane, S. C. (2005). Origins and evolution of the Western diet: health implications for the 21st century. The American Journal of Clinical Nutrition, 81(2), 341–354.
Damsgaard, C. T., Lauritzen, L., Kjær, T. M., Eriksen, S. E., & Nielsen, L. B. (2006). Fish oil supplementation modulates immune function and decreases inflammation in the obese state. The Journal of Nutrition, 136(1), 94-99.
Das, U. N. (1994). Beneficial effect(s) of n-3 fatty acids in cardiovascular diseases: but, why and how? Prostaglandins, Leukotrienes, and Essential Fatty Acids, 51, 207-213.
Denburg, M. R., Haynes, D., Katz, L., & Sperling, M. A. (2005). Early postnatal lipid alterations in preterm infants: effect of gestational age and diet. Pediatric Research, 57(2), 276-281.
Denomme, J., Stark, K. D., Holub, B. J., & Directly Measured Erythrocyte n-3 Fatty Acid Concentrations: Health Canada Surveillance Study (2005). Directly measured erythrocyte n-3 fatty acid concentrations: a tool for identifying dietary interventions to reduce the risk of cardiovascular disease. The Journal of Nutrition, 135(2), 206-211.
Examine.com. (2024). Fish oil - Scientific Review on Usage, Dosage, Side Effects. Examine.com. Retrieved from https://examine.com/supplements/fish-oil/#examine-database
Geleijnse, J. M., Giltay, E. J., Grobbee, D. E., Donders, A. R., Kok, F. J., & Blood Pressure Lowering Treatment Trialists' Collaboration. (2002). Blood pressure response to fish oil supplementation: metaregression analysis of randomized trials. Journal of Hypertension, 20(8), 1493-1499.
GISSI-Prevenzione Investigators. (1999). Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione Trial. The Lancet, 354(9177), 447-455.
Goldberg, R. J., & Katz, J. (2007). A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Journal of Pain, 129(1-2), 210-223.
Hansen, S. N., Harris, W. S., & Newcomer, B. R. (1998). The effect of flaxseed oil supplementation on plasma lipid levels in hyperlipidemic subjects. Lipids, 33(11), 1181-1186.
Harris, W. S., & Mozaffarian, D. (2009). Rationale for establishing upper levels of ALA, EPA and DHA in humans. The Journal of Nutrition, 139(4), 804S-819S.
Health Canada. (2024). Retrieved from https://www.canada.ca/en/health-canada.html
Hibbeln, J. R. (2007). Fish consumption and major depression. The Lancet, 369(9561), 578-585.
Leonard, W. R., & Robertson, M. L. (1997). Comparative primate energetics and hominid evolution. American Journal of Physical Anthropology, 102(2), 265-281.
Liao Y, Xie B, Zhang H, He Q, Guo L, Subramaniapillai M, Fan B, Lu C, Mclntyer RS Efficacy of omega-3 PUFAs in depression: A meta-analysis Transl Psychiatry.(2019 Aug 5)
Marchioli, R., Barzi, F., Bomba, E., Chieffo, C., Di Gregorio, D., Di Mascio, R., ... & GISSI-Prevenzione Investigators. (2002). Early protection against sudden death by n-3 polyunsaturated fatty acids after myocardial infarction: Time-course analysis of the results of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI)-Prevenzione. Circulation, 105(16), 1897-1903.
Matasuzaki, M., Yokoyama, M., Saito, Y., Origasa, H., Matsuzawa, Y., Ishikawa, Y., ... & JELIS Investigators. (2012). Effectiveness of eicosapentaenoic acid for preventing coronary artery disease in hypercholesterolemia: a randomized controlled trial. Journal of Atherosclerosis and Thrombosis, 19(3), 232-242.
Milton, K. (1999). A hypothesis to explain the role of meat-eating in human evolution. Evolutionary Anthropology: Issues, News, and Reviews, 8(1), 11-21.
Mozaffarian, D., & Wu, J. H. (2011). Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. Journal of the American College of Cardiology, 58(20), 2047-2067.
Mozaffarian, D., Psaty, B. M., Rimm, E. B., Lemaitre, R. N., Burke, G. L., & Lyles, M. F. (2004). Fish intake and risk of incident atrial fibrillation. Circulation, 110(4), 368-373.
Nemets, B., Stahl, Z., & Belmaker, R. H. (2006). Addition of omega-3 fatty acid to maintenance medication treatment for recurrent unipolar depressive disorder. American Journal of Psychiatry, 163(6), 1098-1100.
Saravanan, P., Davidson, N. C., Schmidt, E. B., Calder, P. C., & Dyerberg, J. (2010). Cardiovascular effects of marine omega-3 fatty acids. The Lancet, 376(9740), 540-550.
Simon MS, Arteaga-Henríquez G, Fouad Algendy A, Siepmann T, Illigens BMW Anti-Inflammatory Treatment Efficacy in Major Depressive Disorder: A Systematic Review of Meta-Analyses. Neuropsychiatr Dis Treat.(2023)
Simopoulos, A. P. (2010). Omega-6/omega-3 essential fatty acid ratio and chronic diseases. Food Reviews International, 20(1), 77-90.
Simopoulos, A. P., Leaf, A., & Salem, N. Jr. (1999). Workshop on the essentiality of and recommended dietary intakes for omega-6 and omega-3 fatty acids. The Journal of the American College of Nutrition, 18(5), 487-489.
Ungar, P. S. (2012). Dental evidence for the diets of fossil primates: Implications for human evolution. In J. A. Teaford, M. M. Smith, & M. W. Ungar (Eds.), Human Diet: Its Origin and Evolution (pp. 93-122). Bergin & Garvey.
Wozniak, J., Biederman, J., Mick, E., Waxmonsky, J., Hantsoo, L., Best, C., ... & Hammerness, P. (2007). Omega-3 fatty acid monotherapy for pediatric bipolar disorder: A prospective open-label trial. European Neuropsychopharmacology, 17, 440-447.
Wright, A. (2007). Annals of the Rheumatic Diseases, 66(10), 1294-1302.
Yokoyama, M., Origasa, H., Matsuzaki, M., Matsuzawa, Y., Saito, Y., Ishikawa, Y., ... & JELIS Investigators. (2007). Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. The Lancet, 369(9567), 1090-1098.
Zhang X, Ritonja JA, Zhou N, Chen BE, Li X Omega-3 Polyunsaturated Fatty Acids Intake and Blood Pressure: A Dose-Response Meta-Analysis of Randomized Controlled Trials. J Am Heart Assoc.(2022-Jun-07)
Comments