Fish Oil: The Best Source of Omega-3 Fatty Acids

Article by Arnie Gitomer

Fish Oil: The Best Source of Omega-3 Fatty Acids

Why Fish Oil May be the Most Important Nutritional Supplement of the Millennium

by Douglas MacKay, ND

Fish oil was once considered a staple of preventive medicine. Many baby boomers rememberwhen their grandmother made them take cod liver oil from a spoon to stay healthy. As it turns outgrandma was right! Cod liver oil and other fish oils have re-emerged as one of the mostimportant health promoting nutritional supplements of all time.

Fish oil is the best source of two incredibly important essential fatty acids - eicosapentaenoic acid(EPA) and docosahexaenoic acid (DHA). EPA and DHA are omega-3 fatty acids that arerequired by the human body to maintain health and prevent disease. A large body of scientificevidence has shown that the human body does not produce enough EPA and DHA to meet itsown needs and therefore EPA and DHA must be consumed from the diet or supplementation on aregular basis.

Fish oil is currently the most investigated nutritional supplement in the world. Over the pastdecade prestigious academic institutions worldwide have been publishing hundreds of newclinical research studies validating the many health benefits of fish oil. Even the conventionalmedical world could no longer ignore the plethora of proven health benefits and the impressivevolumes of data that support regular supplementation with the essential omega-3 fatty acidsfound in fish oil. Cardiologists, psychologists, dermatologists, and pediatricians are once againstarting to recommend fish oils to their patients.

Omega-3 fatty acids have received recognition and endorsements from the top medicalorganizations and policy makers in the world including, the American Heart Association,American Diabetes Association, World Health Organization, United Kingdom ScientificAdvisory Committee on Nutrition, European Society for Cardiology, and The British NutritionFoundation.

The scientific evidence supporting optimal intake of EPA and DHA is so prolific even themultinational food corporations are feverishly pursuing techniques to fortify food with EPA andDHA. Currently research is being conducted to explore genetic modification of crops such ascorn and soybeans to contain EPA and DHA. In addition, scientists at the University Pittsburghave successfully inserted a gene isolated from a roundworm, into cells from male fetal pigs.Three of ten piglets successfully born had omega-3 concentrations four to five times normal.[Lai, L. et al. Generation of cloned transgenic pigs rich in omega-3 fatty acids. NatureBiotechnology 2006; 24:435-436 ] However, if your goal is to maintain health naturally stickwith Grandma's recommendations for getting enough EPA and DHA - a spoonful of fish oil.

Do not be alarmed if your memories of grandmother's fish oil are not too fond. Fish oilmanufacturing has come a long way. Today's high quality fish oils are manufactured to maintainfreshness, remove potential environmental contaminants and they taste great. Fish oils are nowavailable as liquids or capsules, flavored, and there are even chewable fish oils for kids! If it hasbeen a while since you have given your body enough essential fatty acids, read on to learn all youneed to know about fish oils and the essential fatty acids EPA and DHA.

What are Essential Fatty Acids (EFAs)

The human body can manufacture most of the fats it needs, including cholesterol, saturated fattyacids, and unsaturated fatty acids. However, there are two families of fatty acids, the omega-6and the omega-3 fatty acids, that are considered essential fatty acids. These fatty acids areessential because the parent omega-6 fatty acid, linoleic acid (LA), and the parent omega-3 fattyacid, alpha-linolenic acid (ALA) absolutely cannot be synthesized by the human body and mustbe obtained from the diet or supplementation.

The essential omega-6 fatty acid, linoleic acid (LA), is an 18-carbon molecule that is theprecursor to several other metabolically important omega-6 fatty acids, such as gamma linoleicacid (GLA), dihomo gamma linoleic acid (DGLA) and arachidonic acid (AA).

The essential omega-3 fatty acid Alpha-linolenic acid (ALA) is an 18-carbon molecule that is theprecursor to several distinctly important and health-promoting omega-3 fatty acids includingeicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Sources of Essential Fatty Acids

The primary source of omega-6 fatty acids in the human diet is linoleic acid from the oils ofseeds and grains. Sunflower, safflower, soy, and corn oil are particularly rich in linoleic acid.Evening primrose oil and borage oil, and black currant oil are unique due to their relatively highcontent of the health promoting omega-6 fatty acid, gamma-linolenic acid (GLA).

The primary dietary source of omega-3 fatty acids is alpha-linolenic acid from seeds and seedoils that are derived from plants such as flax, walnuts, and canola. Fish and fish oils are therichest source of preformed long chain omega-3 fatty acids EPA and DHA.

Metabolism of Essential Fatty Acids

Through an inefficient enzymatic process the parent omega-6 and omega-3 fatty acids LA andALA can be metabolized into the functionally important longer chain omega-6 and omega-3 fattyacids. The parent omega-3 fatty acid ALA (18 carbons) can be converted into a small amount ofEPA (20 carbons) and is even less DHA (22 carbons). Scientific studies looking at the ability ofhumans to convert the plant derived omega-3 fatty acid ALA to the health promoting longerchain EPA and DHA have reported between 0.2% - 15% conversion of ALA to EPA with evenless conversion to DHA. [Emken EA, Adlof RO, Gulley RM. Dietary linoleic acid influencesdesaturation and acylation of deuterium-labeled linoleic and linolenic acids in young adult males.Biochim Biophys Acta. 1994;1213:277-288.] [Pawlosky RJ, Hibbeln JR, Novotny JA, et al.Physiological compartmental analysis of alpha-linolenic acid metabolism in adult humans. JLipid Res 2001;42:1257-1265.] It is well established that supplementation with plant oils such asflax oil, which are rich in ALA is not an efficient way to increase levels of EPA and DHA.

In a similar fashion the parent omega-6 essential fatty acids LA (18 carbons) is metabolized toarachidonic acid (20 carbons). Arachidonic acid is one of the primary functionally importantomega-6 fatty acids. Arachidonic acid and EPA are the yin and yang of functionally significantfatty acids - each has important biological roles that are in direct opposition to one another, butwhen in balance foster cell, tissue and whole body health.

The parent omega-3 (ALA) and omega-6 fatty acids (LA) compete for the same enzymes (delta-5and delta-6 desaturase enzymes) for conversion into the longer chain and functionally significantomega-6 and omega-3 fats. The competition between the parent omega-6 and omega-3 fatty acidsfor conversion into the longer chain fatty acids is biologically important because the action ofomega-6s is to create inflammation, while omega-3s are anti-inflammatory. The proinflammatoryversus anti-inflammatory action of essential fatty acids has proven to be of paramountimportance to human health and will be elaborated on later in this chapter.

High intake of omega-6 fatty acids from vegetable oils such as corn, safflower, sunflower, andcottonseed oils has been shown to inhibit the conversion of the plant-based omega-3 ALA to thelonger chain EPA and DHA. Because of the health promoting effects of the long chain omega-3fatty acids EPA and DHA and the relatively low rate of conversion from ALA, EPA and DHAare considered "conditionally essential fatty acids".

Currently there is an overwhelming scientific consensus that adequate intake of fish and fish oilsupplements that provide preformed EPA and DHA is important for the prevention of manycommon chronic disease states. Supplementation with plant-based oils, such as flax oil, whichsupply ALA has not been shown to provide the same health benefits as fish oil supplementation.In addition, a large body of scientific evidence suggests that maintaining a balanced ratio ofomega-6 to omega-3 fatty acids is key to foster optimal health.

Balance of Omega-6 to Omega-3 is Key to Good Health

Humans have evolved eating a diet that contained approximately equal amounts of omega-3 andomega-6 fatty acids. About 100 years ago, the industrial revolution introduced technology thatallowed for the refining of vegetable and seed oils such as corn, cottonseed, soy, sunflower, andsafflower oils. The increased availability of vegetable oils lead to a dramatic rise in theconsumption of omega-6 fatty acids amongst the industrialized countries. In addition, theintroduction of animal feeds derived from grains rich in omega-6 fats has resulted in theproduction of meat, fish, and eggs high in omega-6 fats and virtually void omega-3 fats. Forexample grass-finished beef contains approximately 4% omega-3 fats as compared to 0.4% ingrain finished. [Marchello, MJ. Nutrient composition of grass and grain finished bison. GreatPlains Research 11:65-82, 2001. ]

Today, in Western diets, the ratio of omega-6 to omega-3 fatty acids ranges form 15:1 - 30:1instead of the pre-industrial range of 1 - 2:1.[Simopolous, AP. Essential Fatty Acids in health andchronic disease Am J Clin Nutr 1999;70:560S-569S] A large body of scientific evidence hasestablished that a Western diet that provides high levels of omega-6 fats shifts the physiologicalstate to one that promotes thrombosis, vasoconstriction, inflammation, and poor cellular health.

The physiologic changes that result from high intake of omega-6 fats has been implicated indevelopment of heart disease, diabetes, autoimmune and inflammatory diseases (rheumatoidarthritis, Crohn's disease, colitis, multiple sclerosis, lupus, asthma, etc.), depression, dementiaand other chronic diseases. Excess omega-6 consumption and the correspondingproinflammatory physiologic state is considered one of the most pressing public health issues ofthe twentieth century.

It has been suggested that increased intake of omega-3 fatty acids with the concurrent reductionin omega-6 consumption is a simple public health intervention that could have significant impacton the health of modern society. This one simple diet change could improve quality of life,reduce health care costs, and promote healthy aging.

How Does Fish Oil Benefit Our Health?

Starting in 1970 with Dr. Jorn Dyberberg's landmark study of the eating habits of the GreenlandEskimos, clinical research into the many health benefits of diets rich in EPA and DHA andsupplementation with fish oil has been one of the most impressive and prolific areas ofnutritional science in the past 30 years. Literally thousands of scientific publications and clinicaltrials have established many health benefits of EPA and DHA.

There are four primary mechanisms that omega-3 fats are thought to impact the human body.These mechanisms include the following:

• influencing cell membrane characteristics

• modulating the inflammatory response via eicosanoid production

• protecting cells via metabolism into 'resolvins' and 'protectins' and

• influencing genetic expression.

Omega-3s as Components of Cell Membranes

The health benefits of fish oil boil down to a few simple concepts. First and foremost, EPA andDHA are absolutely essential for proper cellular health. EPA and DHA are required constituentsof ALL cell membranes from our head to our toes and inside out. As constituents of cellmembranes EPA and DHA are determinants of many important cell functions including, cellreceptor action, hormone binding, cell fluidity, signal transduction, ion channel function, andmembrane-bound enzyme activity. [Lerman R. Essential Fatty Acids. Integrative Medicine2006;5:34-44.]

There are literally thousands of prescription drugs designed to modify one or more of the cellmembrane functions mentioned above. Fish oil is a single non-toxic health promoting substancethat can influence ALL of these actions. The overall health of every cell is dependent on its cellmembrane. A cell membrane surrounds and protects the cell, allows nutrients into and waste outof the cell and facilitates cell-to-cell communication.

Omega-3 fats are especially concentrated in the cell membranes of the brain, eyes, nervous tissue,and spermatozoa. In these tissues DHA constitutes approximately 35% of total fatty acids. [LinDS, Connor WE, Wolf DP, et al. Unique lipids of primate spermatozoa: desmosterol anddocosahexaenoic acid. J Lipid Res 1993;34:491-499/ Neuringer M, Connor WE, Lin DS, et al.Biochemical and functional effects of prenatal and postnatal omega 3 fatty acid deficiency onretina and brain in rhesus monkeys. Proc Natl Acad Sci U S A. 1986 ;83:4021-4025.] Theearliest signs of essential fatty acids deficiency usually will develop in these omega-3 richtissues.

Many cells in the human body are constantly recycled and are programmed to replace themselvesevery 30 to 60 days. Omega-3 fats are required for the synthesis of new cell membranes and therepair of existing cell membranes. It is noteworthy that cell membranes not only surround andprotect every cell in the body but also surround each cell organelle within the cell. A cellorganelle is the functional unit within the cell that carries out all of the activities designated tothat cell.

Omega-3s Modulate the Inflammatory Response

The second major benefit of EPA and DHA is related to their important role in the immunesystem as moderators of the inflammatory response. The omega-3 fatty acids EPA and DHA areprecursors to a family of hormone like messenger molecules known as 'eicosanoids' that act aspotent anti-inflammatory agents in the body. The omega-3 eicosanoids counter-balance theomega-6 derived eicosanoids, which act as proinflammatory agents.

Inflammation is part of the body's healing process and is a normal protective mechanism. Theimmune response is dependant on the delicate balance between the activities of omega-6 andomega-3 derived eicosanoids. The over consumption of omega-6 fatty acids causes inflammationto become a long-term physiological state with disease-causing consequences. Long-terminflammation can result in chronic pain, breakdown of cartilage and muscle, increased bloodclotting, increased development of atherosclerotic plaques, and genetic changes that promotemetabolic syndrome and other forms of cell dysfunction. In fact, recent medical research hasdetermined that chronic inflammation is the root cause of several chronic diseases ranging fromarthritis, heart disease, ADHD, asthma, eczema, depression, and cancer.

The inflammatory response is activated when the body is exposed to trauma, allergens, toxicchemicals or disease. Activation of the inflammatory response causes omega-3 and omega-6 fattyacids to be released from cell membranes and quickly converted into eicosanoids that signal thesurrounding tissue to respond.

Omega-6 fatty acids are converted into pro-inflammatory eicosanoids that promotevasoconstriction, increase blood clotting and increased pain and inflammation. Omega-3 fattyacids and GLA are converted into eicosanoids that support an anti-inflammatory immuneresponse and help the body quickly return to homeostasis.

If the omega-6 and omega-3 fatty acids are not in balance inflammation can become a long-termcondition with dire, disease causing consequences.

As you can see the essential fatty acids EPA and DHA not only make up the semi-permeable cellmembrane that protects a cell from its surroundings they also serve as a reservoir of precursormolecules for making eicosanoids. As precursors to eicosanoids EPA and DHA are a vital part ofmaintaining cellular health and reducing inflammation.

Scientists are just beginning to understand and appreciate the power and complexity of theimpact of inflammation on health and disease. The importance of a balance of dietary omega-6and omega-3 fatty is a true example of how diet impacts health. Deficiency of omega-3 fatsresults in long-term inflammation, which is one of the top 10 reasons that patients visit theirdoctor. 

Pharmaceutical companies have spent billions of dollars trying to block inflammation. One of themost profitable drug categories throughout history, the non-steroidal anti-inflammatory drugs(NSAIDs), which includes ibuprofen, aspirin, Aleve, Bextra, Vioxx and Celebrex are designed toprevent the formation of proinflammatory omega-6 derived eicosanoids.

The prevalence of chronic inflammation in our society is reinforced by the impressive sales ofanti-inflammatory drugs, which in 2003 reached 20 billion dollars in the US alone. Unfortunatelylong-term use studies now show that many of these drugs can greatly increase the risk of stomachirritation, ulcers, heart attack, stroke and potentially lethal stomach bleeding. Luckily fish oil hasbeen proven to be an extremely safe and effective way to lower inflammation and therebyprevent the diseases associated with it.

New Anti-inflammatory Mechanisms Discovered

Over the past 30 years of fish oil research the anti-inflammatory activity of fish oil has beenattributed mainly to EPA. What about DHA? From a biochemists perspective EPA and DHA arestructurally similar. They both reside in the cell membrane, and both are released from the cellmembrane when the immune system is triggered. Recently it has been discovered that both EPAand DHA function synergistically to mitigate excess inflammation and promote health andlongevity.

A new group of compounds derived from omega-3 fats were discovered in resolvinginflammatory tissue, and appropriately named 'resolvins'. Compounds synthesized from EPA areresolvins of the E series, while those formed from DHA are denoted as either resolvins orprotectins (formerly neuroprotectins) of the D series. [Serhan CN, Gotlinger K, Hong S, et al.Resolvins, docosatrienes, and neuroprotectins, novel omega-3-derived mediators, and theiraspirin-triggered endogenous epimers: an overview of their protective roles in catabasis.Prostaglandins Other Lipid Mediat 2004;73:155-172.] 

The resolvins and protectins are part of the molecular mechanisms that aids in the removal ofinflammatory cells and restoration of tissue homeostasis once the need for inflammation is over.During the inflammatory response white blood cells are produced to counter the effects of traumaand disease causing organisms. However, if the inflammatory response is not stopped the whiteblood cells begin to cause trauma and tissue damage. Resolvins have an important role inregulating and inhibiting the harmful effects of unopposed inflammation and signaling the whiteblood cells to stop.

Neuroprotectins operate in the same way as resolvins but are concentrated within the brain andnervous tissue. In addition, it has been shown that neuroprotectins protect the tissue of the eyesfrom the damaging effects of light and oxidative stress. Neuroprotectins have also shown exhibitprotective effects in animal models of stroke and of Alzheimer's disease. [Serhan CN. Novelomega -- 3-derived local mediators in anti-inflammation and resolution. Pharmacol Ther2005;105:7-21.] The data on Alzheimer's disease is so impressive that in 2007 the NationalInstitute on Aging (NIA) initiated an 18-month clinical trial, conducted at 52 sites across theUnited States that will see if omega-3 fats can help slow the progression of Alzheimer's disease.For more information about this study you can contact the NIA's Alzheimer's Disease Educationand Referral Center at 1-800-438-4380

Resolvins and neuroprotectins are an exciting and emerging area of research that continue toprovide an expanded understanding of the impact of how EPA and DHA are partners indampening inflammation and improving human health.

Omega-3s Influence Gene Expression

Omega-3 fatty acids are important macronutrients for the growth and development of all humans.In addition to their effect on membrane composition and their ability to modulate inflammationomega-3 fats influence gene expression, leading to changes in metabolism, growth, and celldifferentiation. The effects of dietary fat on gene expression reflect an adaptation response tochanges in the quantity and type of fats we ingest.

There are cell receptors that sit just outside of the nucleus of a cell that are known as peroxisomeproliferator-activated receptors (PPARs). When these receptors are activated they regulate genesimportant in metabolism and cell differentiation. Activation of PPAR receptors is known toimprove insulin function, help metabolize dietary fats, and reduce the formation of new adiposetissue.

PPAR receptors are the target of several pharmaceutical drugs including the thiazolidinediones(eg, rosiglitazone), which are insulin-sensitizing drugs used in the treatment of diabetes andfibrate drugs (eg, fenofibric acid), which are used in patients with metabolic syndrome to lowertriglyceride-rich lipoproteins.

As always, nature has beaten the pharmaceutical industry by designing the perfect PPARactivator and including it in a healthy diet. EPA and DHA from fish oil serve as natural triggersthat activate the PPAR binding site. The influence of EPA and DHA on gene regulation isanother emerging area of research. PPARs are major players in cellular energy balance andcalorie use, the handling of fatty acids and other lipids, and the generation and remodeling ofadipose tissue. The ability of omega-3 fatty acids to influence PPARs provides more evidence tosupport their use in therapeutic areas such as diabetes, obesity, metabolic syndrome andcardiovascular disease.

[Li H, Ruan XZ, Powis SH, et al. EPA and DHA reduce LPS-induced inflammation responses inHK-2 cells: evidence for a PPAR-gamma-dependent mechanism. Kidney Int 2005;67:867-74. ]

[Mishra A, Chaudhary A, Sethi S. Oxidized omega-3 fatty acids inhibit NF-kappaB activationvia a PPARalpha-dependent pathway. Arterioscler Thromb Vasc Biol 2004;24:1621-7. ]

Proven Benefits of Essential Fatty Acids

1. General Health and Well-Being [EPA/DHA blend]

EPA and DHA found in fish oil are physiologically essential omega-3 fatty acids that are acritical aspect of basic health and well-being. Omega-3 fats aid in the normal growth anddevelopment of the human body and are particularly important for the proper development of thebrain, eyes, and nerve tissue.

A large body of scientific evidence suggests that aberrant inflammation underlies many commonchronic diseases and is an obstacle to overall good health. The direct role of omega-6-derivedeicosanoids in promoting inflammation and EPA- and DHA-derived eicosanoids in promotingthe resolution of inflammation has initiated much scientific interest in the influence of theomega-6:omega-3 ratio on human health.

Higher omega-3 intake is associated with several parameters of good health and well-beingincluding improved mood, [Iribarren C, Markovitz J, Jacobs D, et al. Dietary intake of n-3, n-6fatty acids and fish: relationship with hostility in young adults--the CARDIA study. Eur J ClinNutr 2004; 58(1):24-31.], body composition and metabolism,[ Karlsson M, Mårild S, BrandbergJ, et al. Serum Phospholipid Fatty Acids, Adipose Tissue, and Metabolic Markers in ObeseAdolescents. The North American Association for the Study of Obesity 2006:14; 1931-1939.][Neschen S, Morino K, Dong J,et al. n-3 Fatty Acids Preserve Insulin Sensitivity In Vivo in aPeroxisome Proliferator-Activated Receptor-{alpha}-Dependent Manner. Diabetes2007;56(4):1034-41], bone strength [ Weiss LA, Barrett-Connor E & von Mühlen D. Ratio ofn-6 to n-3 fatty acids and bone mineral density in older adults: the Rancho Bernardo Study. Am JClin Nut, 2005;81(4):934-938], memory, respiratory function, [Burns J, Dockery D, Neas L, etal. Low dietary nutrient intakes and respiratory health in adolescents. Chest 2007;doi:10.1378/chest.07-0038.] skin health[Boelsma E, Hendriks HFJ, and Roza L. Nutritional skincare: health effects of micronutrients and fatty acids. Am J Clin Nut, 2001;73(5):853-864.], eyehealth [Nicolas G Bazan. Cell survival matters: docosahexaenoic acid signaling, neuroprotectionand photoreceptors. Trends Neurosci, 2006], attention, and focus. Ross BM, McKenzie I, Glen I,Bennett CP. Increased levels of ethane, a non-invasive marker of n-3 fatty acid oxidation, inbreath of children with attention deficit hyperactivity disorder. Nutr Neurosci, 2003; 6(5):277-281.] and more. In a population-based study involving 2,416 adolescents and adults living inNew Zealand, there was a positive association between higher serum omega-3 concentration andphysical well-being, and self-reported mental well-being. [Crowe FL, et al. Serum phospholipidn-3 long-chain polyunsaturated fatty acids and physical and mental health in a population-basedsurvey of New Zealand adolescents and adults. Am J Clin Nutr 2007;86:1278-1285.]

When it comes to living a long and prosperous life omega-3 fats are once again showing promise.When the cell membranes of centenarians (those who lived past 100) where compared to elderlycontrols several distinct features were discovered. One of the main differences noted higherlevels of the omega-3 fatty acids EPA and DHA and reduced content of the proinflammatoryomega-6 fatty acids linoleic and arachidonic acid. In addition, centenarians had lower levels ofsaturated fats, and reduced susceptibility to free radical damage when compared to elderlycontrols. The authors concluded that the differences observed in the cell membranes ofcentenarians might act in a protective manner that positively influenced longevity. This meansthat higher levels of EPA and DHA within the cell membrane may correlate with a living longer!

[Rabini RA, Moretti N, Staffolani R, et al. Reduced susceptibility to peroxidation of erythrocyteplasma membranes from centenarians. Exp Gerontol 2002;37:657-663.]

2. Cardiovascular Health

Cardiovascular diseases, including stroke, continue to be our nation's number one killer. Since1963 the American Heart Association has been dedicated to urging Americans to be proactiveagainst the development of cardiovascular diseases.

The foundation of preventive medicine for cardiovascular disease is exercise and good nutrition.Possibly the most important heart-healthy nutrients are the omega-3 fats, EPA and DHA fromfish and fish oil. New and important findings are continually being reported about the benefits offish oil on cardiovascular disease.  These include evidence from randomized, controlled clinicaltrials about how omega-3 fatty acids improve heart health by reducing triglyceride levels,decreasing the growth of atherosclerotic plaques, improving arterial endothelial function,lowering blood pressure, and reducing the risk of thrombosis. [Kris-Etherton PM, Harris WS,Appel LJ; American Heart Association. Nutrition Committee. Fish consumption, fish oil,omega-3 fatty acids, and cardiovascular disease. Circulation. 2002 Nov 19;106(21):2747-57.]Fish oil is also a powerful supporter of the body's natural anti-inflammatory response, which alsocounteracts the progression of heart disease.

Evidence from prevention studies suggests that taking EPA+DHA ranging from 500 mg to about1,500 mg per day significantly reduces deaths from heart disease (all causes). The AmericanHeart Association (AHA) recognizes the significant and ever growing body of scientific evidencethat shows how important omega-3 fats are for cardiovascular health. The AHA recommends thatAmericans with existing risk factors for cardiovascular disease should consume a minimum of 1gram of EPA + DHA per day. Individuals with elevated triglycerides need 2 to 4 grams of EPA +DHA daily. Recently the AHA realized that these recommendations are more than can readily beachieved through diet alone and recommend a high quality fish oil supplement. [Kris-Etherton]

The most rigorous clinical evidence supports using fish oil to benefit the heart of healthy people,and those at high risk of - or who have heart disease. The evidence is so strong that it has beensuggested that cell membrane levels of omega-3 fatty acids should be introduced as a screeningtool to assess one's risk of death from heart disease.

Red blood cell (RBC) membrane fatty acid composition reflects long-term intake of dietary fat. Ithas been proposed that RBC levels of EPA and DHA represent a physiologically relevant, easilymodified, independent, and graded risk factor for death from coronary heart disease that couldhave significant clinical utility as a screening tool. RBC EPA +DHA levels of greater than 8%have been associated with an impressive 90 % less risk for sudden cardiac death, as compared tolevels of  less than 4%. [von Schacky C, Harris WS. Cardiovascular benefits of omega-3 fattyacids. Cardiovasc Res. 2007 Jan 15;73(2):310-5.]

Red blood cell EPA + DHA levels reflect the omega-3 fatty acid status of a given individual andcan therefore be used as a goal for treatment with EPA and DHA. A reliable risk factor forsudden cardiac death (SCD) for the general population remains to be defined. The use of RBCfatty acid composition as a screening tool for sudden cardiac death may soon be added to the listof blood work done by your physician during a screening physical exam. [von Schacky C, HarrisWS.Cardiovascular risk and the omega-3 index.J Cardiovasc Med (Hagerstown). 2007 Sep;8Suppl 1:S46-9.]

So what can you do to be part of solution instead of part of the problem? Start with making sureyou are getting at least the AHA recommendation of  one gram of EPA + DHA per day. This iseasily achieved by taking two concentrated fish oil soft gels (each soft gel should provideapproximately 550 mg of combined EPA and DHA) per day. If soft gels are hard to swallow, trya high quality fish oil liquid. One teaspoon of liquid Cod Liver Oil contains about 1 gram of EPA+DHA and 600 mg of oleic acid, another fatty acid know to support cardiovascular health. Whentaking more than 3 grams of omega-3 fatty acids from supplements it is important to inform yourdoctor.

Make sure to find a fish oil product that is completely fresh and free from rancidity, which willequate to a fish oil product that tastes great. If a fish oil product is rancid it will repeat (fishburps) and the many benefits of fish oil will not be obtained, because the bad taste and smell willprevent you from taking it daily. The key to using fish oil to prevent heart disease is finding afresh, high quality, and great tasting fish oil product that you are comfortable taking from nowuntil you are 108.

3. Cognitive Health

Research has shown that omega-3 fats are necessary to develop, maintain, and protect structuresof the central nervous system from conception through pregnancy and undoubtedly, throughoutlife. There is some debate with regards to the relative importance of EPA versus DHA, but thereis an overall scientific consensus that both EPA and DHA contribute to cognitive health anddevelopment as well as mental wellbeing, behavior, learning and mood.

Evidence suggests that DHA is particularly important for development of the brain and nervoussystem in infants. DHA also protects and repairs the brain and nervous tissue from age-associateddamage, which improves mental function and prevents dementia and Alzheimer's in the agingpopulation. DHA is a key structural component of brain and compromises approximately 20% ofthe dry mass and 35 % of the total fatty acids found within the brain. [Richardson AJ. Clinicaltrials of fatty acid treatment in ADHD, dyslexia, dyspraxia and the autistic spectrum.Prostaglandins Leukot Essent Fatty Acids. 2004;70:383-390/ Proc Natl Acad Sci U S A. 1986;83:4021-4025.](repeat)]. Research shows that omega-3 supplementation can improve cognitivefunction in infants and toddlers, as well as improve cognitive performance in individuals 70+years of age in a dose-dependent manner. [Nurk E, et al. Cognitive performance among theelderly and dietary fish intake: the Hordaland Health Study. Am J Clin Nutr 2007;86:1470-1478.]

Published clinical trials suggest that EPA has a particular affinity for conditions associated withaltered mood and behavior including depression, bipolar disorder, schizophrenia, and ADHD. Research has shown that lower levels of omega-3 fats are found in individuals that suffer fromdepression [Maes M, Christophe A, Delanghe J, et al. Lowered omega3 polyunsaturated fattyacids in serum phospholipids and cholesteryl esters of depressed patients. Psychiatry Res.199922;85:275-291./ Hibbeln JR. Fish consumption and major depression. Lancet.1998;351:1213.] and bipolar disorder [Noaghiul S, Hibbeln JR. Cross-national comparisons ofseafood consumption and rates of bipolar disorders. Am J Psychiatry. 2003;160:2222-2227.].Clinical trials have also shown that supplementation with fish oil improves symptoms ofdepression, bipolar disorder, and schizophrenia.

Similar correlations between lower levels of omega-3 fats have been identified in children thathave difficulties with learning, behavior, reading spelling, language development and childrenwith ADHD. [Stevens LJ, Zentall SS, Abate ML, et al. Omega-3 fatty acids in boys withbehavior, learning, and health problems. Physiol Behav. 1996;59(4-5):915-20./ Antalis CJ,Stevens LJ, Campbell M, et al. Omega-3 fatty acid status in attention-deficit/hyperactivitydisorder. Prostaglandins Leukot Essent Fatty Acids. 2006;75:299-308./ Richardson AJ,Montgomery P.The Oxford-Durham study: a randomized, controlled trial of dietarysupplementation with fatty acids in children with developmental coordination disorder./Pediatrics. 2005 May;115(5):1360-6. / Patrick L, Salik R. Benefits of Essential Fatty AcidSupplementation on Language and Learning Skills in Children with Autism and Asperger'sSyndrome] In a recent study one gram daily of Nordic Naturals Complete 3-6-9 was shown tosignificantly increase language and learning skills in children diagnosed with Autism andAsperger's. The highly significant results of this pilot trial show promise for children with autismspectrum disorder. [Patrick]

In 2007, a group of international experts was assembled by the Committee on Research onPsychiatric Treatments of the American Psychiatric Association (APA) to determine if theavailable data support the use of omega-3 essential fatty acids (EFA) for clinical use in theprevention and/or treatment of psychiatric disorders. After reviewing the evidence the groupconcluded that the preponderance of epidemiologic and tissue compositional studies supports aprotective effect of omega-3 EFA intake, particularly EPA and DHA, in mood disorders. Thecommittee summarized their recommendations for use of EPA and DHA in psychiatric disordersas follows: all adults should eat fish at least or more than 2 times per week; patients with mood,impulse-control, or psychotic disorders should consume 1 g EPA + DHA per day; higher levelsof omega-3 supplementation may be useful in patients with mood disorders (1-9 g per day) undera doctors care; and the use of > 3 g per day should be monitored by physician. [Freeman MP,Hibbeln JR, Wisner KL, et al. Omega-3 Fatty Acids: Evidence Basis for Treatment and FutureResearch in Psychiatry. J Clin Psychiatry, 2006;67(12):1954-1967.]

It is noteworthy that the committee's recommendations are similar to the American HeartAssociation (AHA) recommendations for EPA and DHA consumption. As of 2008 Americansare without Recommended Daily Allowances (RDA) or Optimal Daily Intake (ODI) guidelinesfor EPA and DHA. Thus, the AHA and APA guidelines are good benchmarks for omega-3consumption in general.

4. Anti-inflammatory

Inflammation is a normal protective physiological mechanism, but several factors in the Westerndiet, including excess omega-6 fats and a relative deficiency of omega-3 fats, results in long-terminflammation. Omega-3 fatty acids from fish oil have anti-inflammatory effects due to thecompetition of EPA with arachidonic acid in the cyclooxygenase and lipoxygenase pathways. Inaddition, the formation of resolvins and protectins contribute to the removal of inflammatorycells and restoration of tissue homeostasis once the need for inflammation is over. 

Chronic pain affects 80% of Americans and is the second most common neurological ailment inthe United States. Chronic pain has many different causes, however all cases of ongoing painshare one unifying principle - excess circulating proinflammatory omega-6 derived eicosanoids.Epidemiological evidence has demonstrated that omega-3 fats are decreased in patients thatsuffer from chronic pain and inflammation. Randomized controlled trials have demonstratedreduced morning stiffness and joint tenderness with regular oral intake of fish oil. [Goldberg RJ,Katz J. A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acidsupplementation for inflammatory joint pain. Pain. 2007 May;129(1-2):210-23.]

In a study conducted by neurosurgeon, Joe Maroon, team physician for the Pittsburg Steelers,Nordic Naturals ProEPA was given to 125 patients with low back pain. Over 50% were able todiscontinue prescription medication for pain. In addition 86% said they would continue takingfish oil because they felt better in other ways (mood improvement, decreased joint pain, decreaseshoulder pain, etc) [Maroon JC, Bost JW. Omega-3 Fatty acids (fish oil) as an anti-inflammatory:an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain. Surgical Neurology2006;65:326-331.]

Pharmacological anti-inflammatory drugs are effective in reducing inflammation but carrypotentially dangerous side effects, rendering them impractical for long-term use. Severalwell-designed clinical trials have examined the use of fish oil on nonsteroidal anti-inflammatorydrug (NSAIDS) use or steroid use in non-surgical back pain and rheumatoid arthritis. These trialsshow that fish oil consistently demonstrated a reduced requirement for anti-inflammatory drugsand improved clinical outcomes. [Calder PC. n-3 polyunsaturated fatty acids, inflammation, andinflammatory diseases. Am J Clin Nutr. 2006 Jun;83(6 Suppl):1505S-1519S.]

Fish oil has been successfully used in a range of conditions related to chronic inflammationincluding rheumatoid arthritis, Crohn's disease, ankylosing spondyltitis, and back and joint pain. The anti-inflammatory benefits of fish oil are generally attained at a minimum dose of 3 grams ofEPA +DHA and require 8 to 12 weeks of supplementation.

5. Pregnancy, Infancy, and Breast Feeding

DHA is a significant structural component of the brain, eyes, and nervous system, which all arerapidly developing throughout the last trimester of pregnancy and the early stages of life. Thefetus is dependent on its mother for DHA intake, which must be sufficient to maintain her ownhealthy levels and meet fetal demands, especially during the period of rapid nervous systemdevelopment (last trimester-age 2).     

Research has shown that Fish Oil supplementation improves DHA status of mothers, their breastmilk, and infants. [van Houwelingen AC, Sørensen JD, Hornstra G, et al. Essential fatty acidstatus in neonates after fish-oil supplementation during late pregnancy. Br J Nutr. 1995Nov;74(5):723-31. Francois CA, Connor SL, Bolewicz LC, Connor WE. Supplementinglactating women with flaxseed oil does not increase docosahexaenoic acid in their milk. Am JClin Nutr. 2003 Jan;77(1):226-33.] Higher DHA status has been correlated with helping womento get pregnant, lowering the risk of premature births, and reducing the risk of post-partumdepression. [Saldeen P, Saldeen, T. Women and Omega-3 Fatty Acids Obstet Gynecol Surv2004;59:722-730.]

Research has also shown that getting enough DHA during pregnancy improves the health ofoffspring in several ways. Studies show that DHA may improve behavior, attention, focus, andlearning in children [Colombo J, Kannass KN, Shaddy DJ, et al. Maternal DHA and thedevelopment of attention in infancy and toddlerhood. Child Dev 2004;75:1254-1267.],reduce therisk of allergies [Dunstan JA, Mori TA, Barden A, et al. Fish oil supplementation in pregnancymodifies neonatal allergen-specific immune responses and clinical outcomes in infants at highrisk of atopy: a randomized, controlled trial. J Allergy Clin Immunol 2003;112:1178-1184.},positively influences immune development, [Dunstan JA, Roper J, Mitoulas L, Hartmann PE, etal. The effect of supplementation with fish oil during pregnancy on breast milk immunoglobulinA, soluble CD14, cytokine levels and fatty acid composition.Clin Exp Allergy2004;34:1237-1242.] and increase indices of intelligence in babies and children [[Helland IB,Smith L, et al. Maternal supplementation with very-long-chain n-3 fatty acids during pregnancyand lactation augments children's IQ at 4 years of age. 

Pediatrics 2003;111:e39-44]. A Scandinavian study found that  children born to mothers who hadtaken cod liver oil (2 tsp/day) during pregnancy and lactation had higher IQs than those born tomothers who had taken the corn oil placebo.{Helland} Lower brain DHA levels are alsoassociated with cognitive deficits and increased behavioral indicators of anxiety, aggression, anddepression in children [McNamara RK, Carlson SE. Role of omega-3 fatty acids in braindevelopment and function: potential implications for the pathogenesis and prevention ofpsychopathology. Prostaglandins Leukot Essent Fatty Acids 2006;75:329-349.]

In the US, Dietary Reference Intakes (DRI) for DHA during pregnancy has not been established.However, the world's leading experts on lipids and human nutrition have conclude that duringpregnancy and lactation women must ensure a minimum DHA intake of 300 mg daily.[Simopoulos AP, Leaf A., Salem N. Workshop on the essentiality of and recommended dietaryintakes for Omega-6 and Omega-3 fatty acids: Conference Report. J Am Coll Nutr1999;18:487-489]

6. Ocular Health

Omega-3 fatty acids from fish oil help maintain healthy structure and function of the oculartissue by supporting the body's natural anti-inflammatory response, supporting tear production,and protecting eyes from oxidative damage. DHA (docosahexaenoic acid) is particularlyimportant for the eyes and attains its highest concentration anywhere in the body within the eyetissue. DHA accounts for approximately 30-35% of the total fatty acids found within the eye.Certain unique biochemical characteristics of DHA make it vital for the development, function,and maintenance of the highly active, light-receiving cells found in the eye.

Research has shown that DHA is necessary to develop, maintain, and protect visual structuresfrom conception through pregnancy, infancy, and throughout life. DHA supplemented duringpregnancy plays a role in the maturation of the visual system and DHA supplementation of infantformula supports visual acuity.[ Birch E, Garfield S, Castaneda Y, et al. Visual acuity andcognitive outcomes at 4 years of age in a double-blind, randomized trial of long-chainpolyunsaturated fatty acid-supplemented infant formula. (Epub)] Omega-3 fats support the body'snatural anti-inflammatory response, which can alleviate many ocular symptoms includingdryness, pain, redness, and lack of tear production.

A cross sectional study of over 32,000 women showed that in women who consumed moreOmega-3 fats there was a significant reduction in the occurrence of Dry Eye Syndrome. [.Miljanovi? B, Trivedi KA, Dana MR, et al. Relation between dietary n-3 and n-6 fatty acids andclinically diagnosed dry eye syndrome in women. Am J Clin Nutr 2005;82:887-893.] Higherintake of Omega-3 fats is also associated with decreased likelihood of having age-related maculardegeneration and cataract. [SanGiovanni JP, Chew EY, Clemons TE, et al. Age-Related EyeDisease Study Research Group. The relationship of dietary lipid intake and age-related maculardegeneration in a case-control study: AREDS Report No. 20. Arch Ophthalmol2007;125:671-679./ Townend BS, Townend ME, Flood V, et al. Dietary macronutrient intakeand five-year incident cataract: the blue mountains eye study. Am J Ophthalmol2007;143:932-939.] Consistent evidence suggests that Omega-3 fats, act in a protective roleagainst light, oxygen, and age-associated damage to the eyes. [Rotstein NP, Politi LE, GermanOL, et al. Protective effect of docosahexaenoic acid on oxidative stress-induced apoptosis ofretina photoreceptors. Invest Ophthalmol Vis Sci 2003;44:2252-2259.}

IV. How much fish oil should I take?

It is important to remember that omega-3 fatty acids are essential nutrients that are absolutelyrequired by the body. Without a steady supply of EPA and DHA the body does not functionoptimally. Guidelines from various health organizations agree that diet should be the first sourceof omega-3 fatty acids. To meet the minimum recommended amount of EPA and DHA require aminimum of 2 servings of cold-water fatty fish such as salmon, sardines, herring, anchovies, ormackerel per week. Two serving weekly is equivalent to approximately 200 to 500 mg EPA +DHA per day.

Good quality fatty fish is not a regular part of most people's diet. In addition, much of the fishconsumed by Americans are low in omega-3 fats such as farm-raised fish that is fed omega-6 richgrain. For individuals not getting enough dietary EPA and DHA it is an absolute necessity to takea fish oil supplement daily.

To achieve the documented health benefits of fish oil many experts recommend more than 200 -500 mg EPA + DHA daily. Professionals across several medical disciplines agree that a dailydose of 1,000 mg EPA and DHA per day is required to maintain health, support thecardiovascular system, eyes, and nervous system.

The 1,000 mg EPA + DHA daily suggestion is reflected in both the American Heart Associationand The American Psychiatric Association recommendations of one gram (same as 1,000 mg)EPA + DHA daily for individuals with risk factors for heart disease or mood disorders. One wayto quantify this is to imagine that the millions of Americans on anti-depressants, anti-anxiety andother mood stabilizing drugs as well as those on blood pressure medications, lipid-loweringagents and other heart medications - should all be taking one gram EPA + DHA daily.

Therapeutic doses of fish oil are integral part of the nutritional management of many healthconditions. Fish oil doses used by physicians and in controlled clinical trials range from 2 - 10grams of EPA and DHA. It is noteworthy that clinical studies indicate that to support the body'santi-inflammatory response a minimum of 3 grams of EPA + DHA is recommended.

When choosing the correct fish oil for yourself it important to focus on the amount of EPA +DHA in the fish oil product and not the amount of total fish oil. Fish oil supplements vary inpotency and/or the ratio of EPA and DHA. For example standard fish body oil is approximately18% EPA and 12% DHA, which means 180 mg EPA and 120 mg DHA per 1,000 mg capsule.Conversely, a highly purified fish oil concentrate can contain between 60 -85% EPA + DHA,which is 600 - 850 mg EPA + DHA per 1,000 mg capsule.

V. Safety of Essential Fatty Acid supplementation

The US Food and Drug Administration (FDA) classified omega-3 fatty acids from fish oil as"generally recognized as safe" (GRAS). In fact, The FDA has ruled that up to 3g of EPA plusDHA is safe to be included in the food supply of Americans without fear of adverse events.[AHRQ - Evidence reports and summaries - Effects of Omega-3 fatty acids on cardiovasculardisease.] In addition, there are no known significant drug interactions with omega-3 fatty acids[Covington MB. Omega-3 fatty acids. Am Fam Physician. 2004;70:133-140.]. As with allnutritional supplements it is important to inform your doctor of what you are taking.

One of the cardiovascular benefits of fish oil is related to how fish oil can thin the blood. Theblood thinning effects of fish oil has led to theoretical concerns about increased risk for bleedingat higher doses (above 3 grams EPA + DHA), if taken with blood thinning medications, or beforesurgery. The theoretical risk if clinically significant bleeding has not been verified in a controlledsetting. However, it is not advised to combine fish oil with blood thinning medication or beforesurgery without a doctor's supervision.

Choosing a fish oil product

Molecular delivery form: natural vs synthetic

Fish oil supplements vary in potency and/or ratio of EPA and DHA. There are two main types ofnon-concentrated fish oils. The first is typically derived from the body of smaller pelagic fishsuch as sardines and anchovies and contains approximately 18% EPA and 12% DHA. The othernon-concentrated fish oil is Cod Liver Oil, which is derived from the liver of Cod and containsapproximately 14% DHA and 9% EPA. Cod Liver Oil also contains naturally occurringfat-soluble vitamins A and D, which can fluctuate in concentration with the season.

Concentrated fish oil products begin as non-concentrated fish body oil (18% EPA and 12%DHA) and are then molecularly distilled to increase the amounts of EPA and DHA. The nativefish oil is taken through various manufacturing steps to modify the concentration and ratio ofEPA and DHA. The levels of EPA and DHA can be raised from the initial 20-30% to between 60- 90 % EPA + DHA. A wide variety of concentrations and/or different ratios of EPA:DHA aremade available. These options help to increase patient compliance (less capsules to achieve atherapeutic dose) and to target specific therapeutic needs.

Consumers are often unaware that concentrated fish oil products are manufactured in twodistinctly different molecular forms: one containing synthetic ethyl esters and the othercontaining the re-assembled natural triglyceride structure. In making a fish oil concentrate theindividual fatty acids are first removed form the glycerol backbone, then they undergo moleculardistillation that allows for the relative concentrations of EPA, DHA, and other naturallyoccurring fatty acids to be modified.

Once the desired amounts of fatty acids are achieved, a manufacturer chooses from two distinctlydifferent options.  The first is to use enzymes to reattach the fatty acids to the glycerol backbonein a process known as "re-esterification."  This process reassembles the fatty acids into thenatural triglyceride structure.

The second, less costly manufacturing option is to react the free fatty acids with ethanol(CH3CH2OH).  This results in an "ethyl-ester" fatty acid, a fatty acid that does not occurnaturally anywhere in the human diet. The majority of concentrated EPA and DHA productsavailable to consumers today are in the ethyl ester form, perhaps due to this lower cost ofproduction. Although the majority of fish oil products on the market contain the ethyl ester formof EPA and DHA, current research evidence suggests the triglyceride form is better forabsorption and assimilation.

Fish Oil Freshness ; Does rancid fish oil do more harm than good?

Fish oil is meant to be fresh, just like fish. The biggest problem with deterioration in the qualityof a fish oil product is rancidity, which results in a distinct rank taste and smell, and fishyeructations (stinky fish burps). The main cause of rancidity is oxidative free radical damage tothe double bonds found in EPA and DHA. Taste is directly correlated to freshness and lack ofoxidative damage to the oil. To achieve the benefits of fish oil it is important to choose a freshgreat tasting fish oil that does not repeat.

The therapeutic action and safety of fish oil is in part related to its molecular stability andresistance to oxidative damage. Any oil exposed to light, heat, or oxygen is subject to free radicalattack and oxidative damage. Fish oil is made up of many long chain polyunsaturated fatty acids(PUFAs), which have many double bonds in the chain. Everywhere there is a double bond thereis good opportunity for free radical attack.

Fish oil that has been subject to oxidative damage may do more harm to the body than good [25Turner R, McLean CH, Silvers KM. Are the health benefits of fish oils limited by products ofoxidation? Nutrition Research Reviews 2006;19:53-62. ]Researchers have discovered that freeradical catalyzed peroxidation of omega-3 fatty acids leads to the formation of a family ofcompounds that may be harmful to the body. For instance, free radical damage to DHA leads tothe formation of Neuroprostanes. Neuroprostanes are currently being investigated as markers foroxidative stress in the brain that may contribute to neurodegenerative diseases such asAlzheimer's and Parkinson's. [Montine KS, Quinn JF, Zhang J, et al. Isoprostanes and relatedproducts of lipid peroxidation in neurodegenerative diseases. Chem Phys Lipids2004;128:117-124.]

For those of you who may be taking a commodity grade fish oil purchased at a discount grocerystore. I encouraged you to do a taste test. First chew a Nordic Naturals Pro-Omega capsule, andtake note of the light lemon flavor. Second chew one of the commodity grade capsules.  Nodoubted your senses have detected the higher quality oil fresh oil and distinguished it from thepotentially rancid commodity brand. Commodity grade fish oil will typically carry thecharacteristic rank taste and smell of a bad fish oil product.

Commodity fish oils are typically manufactured starting with low quality material and withouttrying to prevent oxidative damage to the oils. High quality fish oils are manufactured with fishthat is caught specifically to make fish oil. The fish is immediately put under a nitrogen blanketto prevent oxidation and remains under nitrogen throughout processing. The fish oil is processedin a low heat environment and finished product is tested for markers of oxidation to ensure itmeets specific criteria.

It makes sense. If you ordered sushi and it smelled bad, would you eat it? Of course not! Rottenfish is no different than rotten fish oil. A bad smelling and tasting fish oil is nature's way oftelling us that it is not healthy to ingest rancid oil. It will simply add to their body's oxidativestress load and expose them to molecules such as neuroprostanes.

All fish oil manufacturers should be testing their oil for markers of freshness. To test forfreshness, fish oil is analyzed for peroxide value, anisidine value, and totox value. Thesemeasurements give a good indication of how much free radical damage has occurred in the oilwith lower values representing less oxidation. Do not underestimate the value of an old fashiontaste and smell test. If fish oil smells or tastes rank, the test is complete. The next step is to throwthat bottle out. A fresh non-oxidized oil should taste good and not carry an aftertaste.

Fish Oil Quality Standards

Because there are no fish oil quality standards in the United States, individuals must determinewhat standards a manufacturer is voluntarily following-if any-to ensure a fish oil is pure, fresh,and without contamination.

The highest standards in the industry today are the Norwegian Medicinal Standard (NMS) andthe European Pharmacopoeia Standard (EPS). By following these standards a manufacturer canguarantee quality products by measuring potency and setting maximum allowances on peroxide,anisidine, and totox levels and heavy metals, dioxins, furans, PCBs, and other environmentalcontaminants. High quality fish oil manufacturers will often volunteer information to theircustomers about the quality standards that they choose to comply with.

The Best Source of Omega-3 Fatty Acids

Fish oil is unequivocally the best source for the omega-3 fatty acids EPA and DHA. Some puristsstill recommend eating fish to achieve optimal omega-3 levels. Unfortunately contamination ofour oceans has made reaching optimal omega-3 levels via eating fish a potential health hazard.Both the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA)have warned the public about the potential dangers of consuming too-much fish because of theassociated toxins. [U.S. Environmental Protection Agency WEBSITE:http://www.epa.gov/waterscience/fishadvice/advice.html]

The introduction of high quality fish oil supplements that have been processed to removeenvironmental contaminants allows for supplementation of high levels of EPA and DHA forpreventive and therapeutic clinical use without the risk of toxicity. In addition, studies havecompared levels of mercury and organochlorines in fish versus fish oil supplements andconcluded fish oil provide the benefits of omega-3 fatty acids without the risk of toxicity.[Melanson SF, et al. Measurement of organochlorines in commercial over-the-counter fish oilpreparations: implications for dietary and therapeutic recommendations for omega-3 fatty acidsand a review of the literature. Arch Pathol Lab Med 2005;129:74-77. [Foran SE, et al.Measurement of mercury levels in concentrated over-the-counter fish oil preparations: is fish oilhealthier than fish? Arch Pathol Lab Med 2003;127:1603-1605.

Some individuals recommend Flax oil as an omega-3 supplement. Flax oil is an excellent sourceof the long chain omega-3 fatty acid known as alpha-linolenic acid (ALA). This 18-carbon fattyacid is a precursor to EPA (a 20 carbon omeg-3 fatty acid) and DHA (a 22-carbon omega-3 fattyacid).

ALA is not associated with the many health benefits attributed to EPA and DHA. To get EPAand DHA from consuming ALA requires several metabolic steps (elongation and desaturation)that are governed by two important enzymes known as delta-6 desaturase (D6D) and delta-5desaturase (D5D). 

Metabolic studies have shown that the enzymatic activity of D6D and D5D are impaired byintake of saturated and trans fatty acids, alcohol, stress-hormones, smoking, viral infections,ionizing radiation, and ageing. It is hard to find a patient without these obstacles to convertingALA to EPA and/or DHA. If your goal is to achieve the health benefits attributed to EPA andDHA you need to consume pre-formed EPA and DHA from fish or fish oil. If you have concernsabout mercury, organochlorines, and other toxins found in fish - use fish oil.

Nordic Naturals Fish Oils

Nordic Naturals is a company that has set the standard for fish oil excellence. Nordic Naturalsspecializes in essential fatty acid products with a full line of non-concentrated and concentratedfish oil products. They also have specialty products such as chewable fish oils for children andfish oils mixed with other synergistic ingredients to meet the needs of specific health conditions.

Nordic Naturals products are well known for their excellent taste. Taste is directly correlated tofreshness and lack of oxidative damage to the oil. Nordic Naturals has several proprietary stepsused during the manufacturing process to eliminate free radical damage. Using a great tasting fishoil that does not repeat correlates to easily taking the product each day, which is how to getresults.

The owner of Nordic Naturals, Joar Opheim, is a native to Norway and has developedrelationships with independent fishermen that use smaller boats rather than larger trawlingvessels that spend a longer time at sea. This means there is less time between the catch and theinitiation of the oil extraction, which is done in a low heat, nitrogen-rich environment. Thirdparty analysis of Nordic Naturals oils has resulted in anisidine values between 1 and 2, five to 10times below the industry average.

The exceptional taste of Nordic Naturals is key to the quality of their products. Other importantmarkers of quality include, Nordic Naturals uses only 100% triglyceride form oils rather thanethyl ester form for their concentrated fish oils. Nordic Naturals also adheres to NorwegianMedicinal Standard (NMS) and the European Pharmacopoeia Standard (EPS) and third partyanalysis are consistently well below allowable amounts of peroxides, heavy metals, dioxins,furans, and PCBs. Another reassuring fact about Nordic Naturals oils is that leading researchinstitutions around the world choose Nordic Naturals fish oils for their clinical trials. In 2008,Nordic Naturals is active in over 20 clinical trials that are being conducted at prestigiousUniversities around the world. It is clear that by focusing on fish oil, Nordic Naturals continuesset the industry standard for high quality fish oil.

This article was written by Douglas MacKay, ND, a licensed Naturopathic Doctor who iscommitted to the advancement of natural and preventive medicine. A national and internationallecturer, Dr. MacKay divides his time between practice, research and advocacy. Dr. MacKay isthe founder of Makai Naturopathic Center in Dover, NH, which combines Naturopathic,Chiropractic and Chinese Medicine for a unique approach to family medicine. In addition tomaintaining a private practice Dr. MacKay has worked as a medical consultant for the nutritionalindustry and as the medical editor for the Alternative Medicine Review. He has several articlespublished in peer review medical journals and has been featured on many national radioprograms. His lectures blend biochemistry, cell biology, clinical experience, and publishedresearch into a relevant and useful presentation.

Dr. MacKay is currently the Research Advisor for Nordic Naturals.