Something’s fishy here…….

My articles usually are generated from questions we receive at the pharmacy. It seems a lot of folks are interested in fish oil supplements. Here’s the scoop:

What is it? Fish oil is derived from the tissues of oily fish. It is recommended for a healthy diet because it contains the omega-3 fatty acids EPA and DHA (nice short initials for really long chemical names) – these are precursors to something called eicosanoids that work to reduce inflammation throughout the body.

Fish do not actually produce omega-3’s, rather they accumulate them from consuming the algae that produce them or they come from predatory fish that acquire omega-3’s by eating those fish that ate the algae. The problem with the predatory fish at the top of the food chain (e.g. mackerel, lake trout, tuna and salmon) is these species can accumulate toxic substances due to contaminants. The FDA suggests limiting consumption of certain species (e.g. albacore tuna) to limit exposure. This is why many people turn to fish oil supplements.

What does it do? Omega-3’s have been shown to decrease triglycerides, can be helpful in hypertension management, improve morning stiffness and joint tenderness, may be responsible for nerve growth in the frontal cortex of the brain, and have been suggested as beneficial in maintaining several aspects of heart health.

Are the capsules safe? Some fish contain mercury, PCB’s or dioxins. Most supplements are mercury free since mercury accumulates more in the meat than the oils. Additionally a large amount of toxins are removed during manufacturing, but to be safe look for products that are labeled “USP Verified” or products that are guaranteed to be low in contaminants. (We only stock products that are either USP Verified or guaranteed.)

Does fish oil increase LDL (bad cholesterol)? This is possible but is most common in patients with high triglycerides (> 500mg/dl) and taking 4 grams of fish oil a day. It usually isn’t a problem for everyone else.

Is there a bleeding risk? High doses of fish oils do have antiplatelet effects (keeps blood cells from sticking together), but this doesn’t seem to increase the risk of bleeding. However, to be safe, take fish oil with caution if you take other drugs or herbal supplements that can increase bleeding, or are taking high doses of fish oil.

Other side effects? Some folks experience a “fishy” aftertaste. There are coated capsules that help to eliminate this. Another trick is to refrigerate or freeze the capsules to lessen aftertaste. (Yes Dr. Bob I really suggested freezing something.) There is also liquid fish oil that is concentrated and lemon flavored. It is one of our more popular options. Other side effect possibilities are diarrhea and stomach upset. These folks may need to cut back on the amount of fish oil they take or increase their intake gradually. Never take anything that smells or tastes rancid.

What if I’m allergic to seafood? Most allergic reactions to seafood are to the protein, not the oil. It is possible for fish oil capsules to contain some protein so be careful if you are allergic to seafood.

How much do I take? The American Heart Association recommends that healthy adults eat fish at least two times per week. Omega-3 rich fish are fatty fish such as anchovies, bluefish, carp, catfish, halibut, herring, lake trout, mackerel, pompano, salmon, striped sea bass, albacore tuna and whitefish. According to the Mayo Clinic people eating Western diets consume 10 times more omega-6 fatty acids than omega-3 fatty acids. We get most of our omega-6’s from vegetable oils. Since omega-6 and omega-3 fatty acids compete with each other to be converted to active metabolites in the body, benefits can be reached either by decreasing our intake of omega-6’s or increasing our intake of omega-3’s. Good fish oil supplements offer the benefit of omega-3’s without the risk of the toxic contaminants.

How much to take should be based on the amounts and ratios of EPA and DHA, not the total amount of fish oil. A common ratio in fish oil capsules is 180mg of EPA and 120mg of DHA. If you were to get 1000mg of omega-3‘s you’d need to take about 3-4 capsules per day. Read your labels carefully. Some products give the amount of EPA and DHA that is in more than one capsule. Look at the serving size when you calculate how many capsules you’ll need per day.

There are different recommendations for the quantity of fish oil to take based on what is being treated. One rule of thumb is to consume fish and/or fish oil supplements at a dose of 500mg to 1800mg (total EPA + DHA) per day. Talk to your health care provider about what is best for you.

Just remember the old saying, “give a man a fish and he can eat for one day, teach a man to fish and he won’t have to buy fish oil supplements….”.