Update: I now recommend Bio-Avail Omega+ from Adapt Naturals. It’s a blend of ultra-pure fish oil and the most bioavailable forms of curcumin and black seed oil.
Summary
Sorry, folks. Another long one. It was unavoidable, though, because I really did want this to be a “definitive guide” that covers all (or at least most) of the relevant issues involved with choosing a fish oil. Here’s a summary for the time-challenged:
- There are five important factors to consider when choosing a fish oil: composition, purity, freshness, bioavailability, and sustainability.
- Not all fish oils are created equal. It’s essential to do your homework and make an informed choice. Many fish oils are oxidized or made with poor-quality ingredients and may cause health problems instead of solving them.
- The potency of various products depends not only upon the levels of EPA and DHA but also upon the molecular structure of the fats in the oil, which in turn affects absorption.
- Natural triglyceride fish oils are better absorbed than highly purified (i.e. ester) fish oils.
- Many fish oils are made from fish that are endangered. Choose products made from fish that are certified by organizations such as Friend of the Sea or MarinTrust.
Introduction
So far in this series we’ve looked at why fish is superior to plant-based sources of omega-3. We’ve examined the importance of reducing consumption of omega-6 fats. We’ve considered how much omega-3 is needed to support health and treat disease. We’ve revealed that concerns about the safety of fish consumption have been overblown, and that eating fish regularly is not only safe but incredibly beneficial. And in the previous article we compared the benefits of eating fish to taking fish oil.
In this final article of the series, we’re going to take a closer look at fish oil. Fish oil is one of the most popular supplements taken by consumers today. Most people who are at least relatively health conscious understand that they need omega-3 in their diet and are probably not getting enough from food (unless they eat a lot of fish).
But why should you consider taking fish oil in the first place? Which fish oils are best? How much should you take? And what should you look for in a good product?
In this article, I’ll focus more on dispelling common misconceptions about fish oil and helping you to choose the best product for your needs.
My current thoughts on fish oil
My view and recommendations for fish oil have evolved over time.
I’ll tell you what has remained constant first, then tell you what has changed.
I still recommend getting EPA/DHA from the diet whenever possible—either as your exclusive source or as a foundation to build upon.
And I still don’t recommend super-high doses of fish oil, like 10 grams per day. This isn’t common anymore, but there was a time when many health gurus were suggesting this as a way to reduce inflammation. But it’s not supported by research, and there’s no additional benefit beyond the 1-3 grams a day studies suggest is the best therapeutic target.
What has changed is my growing appreciation for the role fish oil can play in ensuring adequate EPA/DHA intake for many people. For all of the reasons I’ve mentioned in this series, many folks are just not getting enough EPA/DHA, and taking a fish oil supplement is probably the only way they’re going to get these critical fatty acids.
It’s also true that some people benefit from greater amounts of EPA/DHA than they can easily obtain in their diet.
My specific recommendations for EPA/DHA supplementation have also evolved. I have recommended cod liver oil for many years, and I still do today. It’s a good option because it contains vitamins A and D in addition to EPA/DHA.
However, the amounts of EPA and DHA are lower in cod liver oil than in most fish oil supplements. And if you’re already consuming organ meats like liver or an organ meat supplement, like Bio-Avail Organ from Adapt Naturals, you don’t really need (or even want) the additional A/D from cod liver oil.
This is why I now recommend a high-quality fish oil supplement for people who are either not getting enough EPA/DHA from their diet or who would benefit from additional EPA/DHA because of a chronic, inflammatory, or autoimmune condition.
But finding a high-quality fish oil is easier said than done. The global market for fish oil is north of $2 billion now. Whenever there’s that much money to be made, you can be sure all kinds of shenanigans will ensue!
So, let’s look at some of the most important factors to consider when buying fish oil.
Factors to consider when buying fish oil
There are five primary variables to be aware of when shopping for fish oil:
- Composition. In order to have the desired anti-inflammatory effect, fish oil must contain an adequate amount of the long-chain omega-3 derivatives EPA and DHA.
- Purity. The oil must meet or exceed international standards for heavy metals, PCBs, dioxins, and other contaminants. Many do not—even when they claim they do.
- Freshness. The oil should be fresh and not rancid. Rancid/oxidized oils promote oxidative damage and increase inflammation, both of which are risk factors for nearly every modern disease. Sadly, many fish oils on the market contain high levels of oxidative by-products.
- Bioavailability. The ability to absorb the beneficial components of fish oil is based on the molecular shape of the fatty acids. The more natural the structure, the better.
- Sustainability: The fish should be harvested in a sustainable manner, and species that are under threat should be avoided.
Composition
Composition refers to the overall concentration of EPA/DHA and the ratio of EPA to DHA. To some extent, this depends on the goal of taking fish oil. For example, some conditions may call for a higher proportion of DHA, while others benefit from more EPA.
Most studies suggest that a 3:2 ratio of EPA to DHA is optimal, with a total amount of omega-3 ranging between 500 mg and 2 g per day.
The optimal amount for each person will vary based on several factors, including how much fish/seafood you’re consuming in your diet. If you don’t eat any, and/or you have an inflammatory or autoimmune condition, you want to aim for the higher end. If you eat some fish/seafood, you can aim for the lower to mid-range.
Purity
Many species of fish are known to concentrate toxic chemicals like heavy metals, PCBs, and dioxins, which can cause serious diseases, especially in children and developing fetuses. In a previous article, I explained how these chemicals are typically not a concern when eating whole fish because fish also contains selenium. Selenium binds to mercury and makes it unavailable to tissues, thus protecting against any damage it may cause.
To address this, fish oil manufacturers use a process called molecular distillation to remove the toxins from the oil. When done correctly, molecular distillation is capable of reducing the toxins in fish oil to levels considered to be safe by the EPA and other agencies.
Although almost any fish oil manufacturer will tell you their product is free of these toxins, independent lab analyses tell a different story. In March of 2010, a lawsuit was filed in California court against the manufacturers of ten popular fish oils because they contained undisclosed and (possibly) unsafe levels of contaminants.
Unfortunately, this kind of deception is all too common in the supplement industry. The best companies will be able to provide a Certificate of Analysis (COA) from the manufacturer upon request. A COA is an analysis performed by an independent lab to measure the ingredients of a product and confirm whether it lives up to the claims made by the manufacturer.
If the manufacturer won’t provide a COA, I start to get suspicious. This is standard practice in the industry, and there’s no reason they shouldn’t be happy to show you theirs.
In general, fish that are lower on the food chain, like sardines and anchovies, naturally have a lower concentration of contaminants. For this reason, it may be wise to look for a product made from these fish.
So what levels of these toxins are safe? As you might imagine, there is some disagreement on this question since there is no single governing body that determines acceptable levels. However, the standards that are most often followed by fish oil manufacturers are summarized in the table below.
* ppt = parts per trillion
* ppb = parts per billion
The best fish oils will not only meet but exceed these international standards.
Freshness
I have written extensively about the dangers of oxidized, rancid oils. They promote oxidative damage and increase inflammation, both of which are risk factors for nearly every modern disease.
This is why it’s crucial to ensure that the fish oil you select is fresh and not rancid. Once it has gone rancid, it will have the exact opposite effect on your body than you want it to.
The first thing to do is to check something called the “peroxide value” on the COA. This is a measure of rancidity reactions in the oil that have occurred during storage. It should be less than 5 meq/kg.
If this checks out, and you decide to order that product, break open a capsule once you receive it. There should be no “fishy” odors. They should smell like the ocean, but not like rotten fish. They should also not have a strong lemon or lime scent, which could be an indicator that the manufacturer is trying to mask the rancidity.
The p-anisidine value measures secondary oxidation products. The IFOS and GOED standard is less than 20 units. However, it’s important to note that p-anisidine is not appropriate for measuring secondary oxidation in omega-3 oils that have a strong color or contain added flavorings.
For example, salmon oil contains carotenoids, which have a natural yellow/orange coloring. Bio-Avail Omega+ from Adapt Naturals contains curcumin, which also has a natural orange coloring. This throws off the p-anisidine values and makes it an irrelevant test.
TOTOX is the last way to measure oxidation. It’s simply a combination of the peroxide and p-anisidine values. (For this reason, it’s also not appropriate for products with a strong color.) The IFOS and GOED thresholds are 19.5 and 26 meq/kg, respectively. But the best products have TOTOX values below 15 meq/kg.
Finally, some studies have shown that adding antioxidants (e.g. curcumin or resveratrol) to fish oil can improve stability.
A common misconception is that you can determine the quality of fish oil by freezing it. The theory goes that if you freeze the oil and it is cloudy, it’s rancid. That is not the case. All fish contain saturated and monounsaturated fatty acids, albeit in small amounts. These fatty acids make the capsules appear cloudy when frozen in products that contain whole fish oil.
Potency
This is another area surrounded by significant controversy. Some argue the levels of individual constituents in fish oil aren’t paramount. Scientists discovered the healthful effects of omega-3s by studying people with fish-heavy diets, before supplemental fish oil even existed. Clinical trials using supplemental fish oils over the past few decades have contained widely variable levels of both long-chain omega-3 derivatives (EPA and DHA), and not super-high concentrations of either or both.
However, due to poor conversion of ALA to EPA and DHA, unless you are eating fish it is very likely you are deficient in long-chain omega-3s.
Following this line of reasoning, the DHA content in particular of fish and fish oils does seem important if we wish to obtain the best possible therapeutic effect. Many recent studies demonstrating the anti-inflammatory potential of fish oil used a daily dosage of DHA in the range of 1-3 grams. What’s more, foods like salmon roe that have been prized by traditional cultures for their nourishing and healing effects contain large amounts of DHA. A single 6 oz. serving of salmon roe contains 1 g of DHA. (In fact, this would be the best way by far of supplementing with DHA if money were no object. (Unfortunately, wild salmon roe goes for about $28/serving.)
Unfortunately, many fish oils do not have significant amounts of DHA. This means you’d have to take an impractically high number of capsules each day to obtain the therapeutic dose. This is not desirable, since all unsaturated oils (including fish oils) are subject to oxidative damage. We don’t want to take large quantities of them for this reason.
Remember to check the label and ensure that your product has approximately 200-300 mg of DHA per capsule. This will allow you to achieve the therapeutic dose by taking no more than 3 capsules twice a day.
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Bioavailability
The ability to absorb the beneficial components of fish oil is based on the molecular shape of the fatty acids. In short, the more natural the structure and the less it is chemically altered, the better.
This is true for any nutrient, of course, and it explains why I am always in favor of obtaining nutrients from food or food-based sources when possible. Each additional step in processing from the natural state of food to extract or isolate nutrients introduces the potential of damaging the nutrient or changing its chemical form so that it’s more difficult to absorb or affects the body in a different way.
When it comes to fish oils, there are three forms currently available on the market:
- Natural triglyercide oil. This is what you get when you “squeeze” the whole fish and extract the natural oil from it. It is the closest to eating fish oil in its natural form and is highly bioavailable. The drawback of this form is that, because it’s not concentrated, it usually has low levels of EPA and DHA. And because it isn’t purified, it can have high levels of contaminants such as heavy metals, PCBs, and dioxins.
- Ethyl ester oil. Occurs when natural triglyceride oil is concentrated and molecularly distilled to remove impurities. The ester form is still in a semi-natural state because it is the result of a process that naturally occurs in the body. The advantage of this form is that it can double or triple the levels of EPA and DHA.
- Synthetic triglyceride oil. This form occurs when natural triglycerides are converted to ethyl esters for concentration (as above) but then re-converted into synthetic triglycerides. The original position of the triglyceride’s carbon bonds changes, and the molecule’s overall structure is altered, which impacts the bioavailability of the oil.
Studies on absorption of the various types of fish oil suggest that, unsurprisingly, the natural triglyceride form is absorbed better than the ethyl ester form, which in turn is absorbed better than the synthetic triglyceride form.
One study by Lawson & Hughes in 1988 showed that 1 gram of EPA and 0.67 grams of DHA as natural triglycerides were absorbed 3.4 and 2.7 fold as well as the ethyl ester triglycerides.
In the previous article, we saw that fish oils were better absorbed when taken with a high-fat meal. In another study by Lawson & Hughes later the same year, they showed that the absorption of EPA & DHA from natural triglycerides improved from 69% with a low-fat meal (8g total fat) to 90% with a high-fat meal (44g total fat). Absorption of both EPA and DHA from ethyl ester oils was increased three-fold from 20% with a low-fat meal to 60% with a high-fat meal.
Sustainability
Our global fisheries are in dire straits, and fish oil is a big business. So, it’s crucial to choose a product that is manufactured with sustainability in mind and that has a fully transparent and traceable supply chain.
The easiest way to do this is to choose a product that is certified by organizations like Friend of the Sea or MarinTrust, two of the leading organizations for sustainable and responsible fishery management.
I would also choose a supplier/manufacturer with practices that minimize waste and its environmental impact.
For example, rather than catching fish that is only used to produce fish oil, some producers instead use fish meal to make the oil. This eliminates one of the main concerns about fish oil, which is that it will further deplete fisheries.
Recommendation
As a Functional Medicine clinician, author, and educator, I’ve been following the fish oil market closely for many years. I’ve used several different fish oils with my patients. I’ve read hundreds of studies on the purity, freshness, composition, and benefits of fish oil. I’ve spoken to industry experts and insiders, and I know what many companies do to cut corners and save money (at your expense).
When I started my own supplement company, Adapt Naturals, I knew that one of the first products we’d make would be fish oil. I wanted to create a product with the purest, freshest, and most sustainable fish oil available. And that’s exactly what we did with Bio-Avail Omega+.
I chose VivoOmega from GC Rieber as our fish oil. As the chart below illustrates, it significantly exceeds international standards for both purity and freshness.
Purity and freshness are critical. But I didn’t stop there. Most people who take fish oil are taking it to achieve certain outcomes, like better muscle and joint health, increased mental clarity, a more stable mood, clearer skin, and more balanced immune function.
So, when I formulated our fish oil product (Bio-Avail Omega+), I added the most bioavailable forms of two powerful nutrients that also support these goals: curcumin and black seed oil.
Now you can get the benefits of all three of these superfood nutrients in a single, two soft-gel daily serving.
Bio-Avail Omega+ contains an optimal composition of EPA and DHA (510 mg of EPA and 330 mg of DHA, a 3:2 ratio). It is made with triglyceride oils for optimal bioavailability and absorption. And it is produced with the most sustainable and traceable fish oil material in the industry. (See this page for more info.)
I’m proud of this product. It came directly out of my experience working with patients for 15 years and my extensive research into what is most important in a fish oil product. I hope it helps you to achieve your health goals!
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Pixie,
Like many other I have spent a lot of time reading through all of the post and your comments. Thank you for all the time you have taken to try and help people out. I saw a post from you on 5/7/13 stating you would add a list go TAG products but I cannot seem to find it? I am trying to find a natural TAG fish oil to use. I suffer from a lot of joint pain and also just stopped chemotherapy. I believe a natural TAG is better than a rTAG is this correct? It would be very helpful if you could list your top natural TAG products. I have used NutraGold Triacylglycerol in the past but I think you said this is a rTAG, correct? Again, if you could list your top natural tags that would be fantastic!
Jacalyn:
Thanks for the reminder.
See this reference for lipases. http://www.ejbiotechnology.info/index.php/ejbiotechnology/article/view/v16n3-5/1603
“The potential use of lipases in the production of fatty acid derivatives for the food and nutraceutical industries”
I have been busy commenting on bogus products being marketed as “Prenatal DHA” towards pregnant and lactating women where the “responsible party” RP, i.e. the marketer, did not disclose the fact that the product contains FDA approved drug products. Several consumers wanted to know more details about these products so that they could make an informed decision before purchase.
Meanwhile, I will look over my collection of more than 1,800 omega-3 dietary supplements that are “natural” and supply “nature-identical” molecules (TAG) that are identical to the TAGs you ate at your first meal on your birth date. Subsequently, your digestive system evolved to protect you from toxins, xenobiotics, snake oil, and synthetic chemicals such as fatty acid ethyl esters. It also provides enzymes for the digestion of TAG, phospholipids, cholesterol, and other important essential nutrients.
As you are aware, real “fish oil” is an edible oil (tri-acyl-sn-glycerols, TAG) like tree nut oils and seed oils that we consume every day. Thus, there are molecules in all these “natural oils” that are identical to the molecules in all of the other natural “edible oils”. For example, olive oil TAGs will have identical TAG molecules that are in fish oil. Then, I don’t recall seeing synthetic olive oil being marketed as “olive oil” that contains the non-nature identical synthetic molecules of ethyl esters that are not oils. Remember, these natural edible oils are obtained by extraction and purification and not by synthesis.
Notice the trend is changing towards more TAG based omega-3 products being introduced into interstate commerce in the US and other countries. Notice how many of the natural TAG products are proud to announce on the principal display panel (PDP) or in the supplement facts panel “Natural Triglyceride”, “Triglyceride”, as the “Natural Triglyceride Form”. Additional marketing of these products explicitly emphasizes “triglyceride” form. How many products do you know that are enthusiastic about the synthetic chemical compounds omega-3 acid ethyl esters in their product? How many products are silent on the chemical form? I wonder if their sales would plunge if they had to put the true identity (21 CFR §111.75(a)) of the dietary ingredients in their products in the supplement facts panel and perhaps on the PDP (main dietary supplement identity). The fact is that without the iconic “fish oil” brand name, products would not sell.
I will work on the list.
Part 1.
Pixe
Pixe,
Thank you for replying so quickly. I appreciate all your research and hard work but to be honest it is a little difficult for me to follow, probably part due to my chemo brain. Basically if you could let me know perhaps your top 5 or top 10 natural TAG fish oils I would really appreciate it. I am suffering from very bad joint pain among other things and would love to be able to order something asap. I am having a difficult time figuring out which brands would be best. It would be extremely helpful while you continue your research if you had any suggestions to offer. Thank you!
Jacalyn:
No problem and I am awaiting new products and will comment on the simple “natural fish oil” dietary supplements.
Meanwhile, a nice review article by Clemens von Schacky titled: “Omega-3 Index and Cardiovascular Health” is a nice starting point for bio-availability. Readers can download the article for free. See the comments on meal affects EE and all those large studies with EE. Of interest, is what and when you take your supplements. While at this journal, the entire issue is devoted to Omega-3 fatty acids. Here is the reference to all the papers, “Open Access”. “Special Issue “Recent Advances in Omega-3: Health Benefits, Sources, Products and Bioavailability”, http://www.mdpi.com/journal/nutrients/special_issues/omega-3_conference.
This is good background information reading.
P
Sorry to keep pestering you about this but I need to order something asap and could really use some advice. Is there any chance you could offer any suggestions while you await the products you plan to research? It would be very grateful if you could offer any advice so I could get something to hold me over until you do further research.
Also, previous to reading your posts I thought there was one type of “natural triglyceride” but if I am understanding correctly there are two types of fish oil in triglyceride form- rTAG and TAG with the TAG being more “natural”, is this correct? Is there a simple way to distinguish between the rTAG and TAG? Or any companies you know sell the TAG? Part of the reason I am asking for your suggestions is I am not sure how to tell the difference between the two.
Thank you for your help – Jacalyn
Jacalyn:
Here is an interesting product that I discussed earlier. It is Coromega’s fish oil emulsion. Each packet supplies 350 mg EPA and 230 mg of supposedly TAG (“Natural triglyceride form”) in an emulsion with pasteurized egg yolk, Stevia, and various other ingredients on my 90 packet box. No fish burps or aftertaste and your children may like it. However, my product expired 4/2014 but still tastes good. You will need to visit their site to get an update on the ingredients at http://www.coromega.com/. What is interesting about the product is that it was reported that the omega-6/omega-3 decreased while taking the product. As you have heard, omega-6s promote inflammation whereas omega-3s are anti-inflammatory.
Details on how these fish oil-in-water emulsions work can be found in the US patent: http://www.google.com/patents/US8241672 . When you open the patent in Google Patents, click on the “Patent Citations” and it will take you to all related patents and other references so that you can get additional information indirectly on reducing inflammation and other health issues.
My suggestion would be to cut back on processed foods and cooking oils such as polyunsaturated vegetable oils, which are high in omega-6s. Try some exercise if possible and cut back on tobacco and alcohol use. Then, try one of those omega-3 index kits to get your omega-3 index before taking Coromega. Try the product and see what happens. I am assuming that there have been no recalls, scandals, etc. for the product. It may take a couple of weeks, steady-state concentration to see an effect. Then, in six months try another omega-3 index, and then you can judge for yourself if the product is working. Cost about $30.00 for three month supply.
Here is the reference to the “clinically proven” article that you can access for free easy to read format (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2701654/ ) and http://www.nutritionj.com/content/pdf/1475-2891-6-4.pdf. Notice the pharmacokinetics (shows the amount of omega-3 getting into your blood plasma) curves in which EPA and DHA were measured in the phospholipid fraction (short term pool) of the blood. Notice the difference in the curves between TAG without the emulsion. Also, notice the patients were on the recommended low-fat diet.
The argument of which chemical form, EE or TAG is better, never takes into the consideration that you have to get to the short term pool (phospholipid fraction) in order to get to the long term pool, your cell membranes. Assume that you take your fish-oil capsules in the morning with a low-fat meal for many months. If there is very little omega-3 getting into the short term pool, how do you expect to get omega-3s into the long term pool?
See http://www.accessdata.fda.gov/drugsatfda_docs/nda/2014/204977Orig1s000ClinPharmR.pdf for the pK curves for taking Lovaza “[4 capsules administered after a high fat, high-calorie breakfast]” 1,860 mg EPA-EE and 1,500 mg DHA-EE. Then look at the curves on Page 8 of the report. If you can overlay the graphs, between http://www.nutritionj.com/content/pdf/1475-2891-6-4.pdf you will see how a low-dose product TAG emulsion will outperform a high-dose EE product even under low-fat meal vs a high-fat meal (EE). Notice that the reviewer for the NDA comments: “A significant food effect on the bioavailability of baseline adjusted total plasma EPA and total plasma DHA was observed, perhaps for the first time, for both AKR-963 and Lovaza® formulations.”
I am sure those who disagree will provide their interpretation, which is good for the opposing view since I am a senior citizen just trying to maximize the absorption of omega-3s that I take.
Therefore, in my opinion, you are wasting your money on dietary supplements with a false sense of cardioprotection, which might lead to “may increase your risk of heart disease.” Does the risk outweigh the benefit? http://www.askapatient.com/adverse-events.asp?drug=OMACOR (omega-3 acid ethyl ester side effects)
I apologize for all the verbiage and the science.
Diet first but if there are issues with getting Omega-3s from diet, try another source such as a dietary supplement. It is not how much omega-3s you take, it is how much gets absorbed.
Disclaimer: My comments, suggestions, and recommendations are not intended to diagnose, treat, cure, or prevent any disease. Consult your health care provider before taking any dietary supplements.
P
Jacalyn:
Sorry for the delay. Sometimes we want a quick fix to a biological problem whether it be genetic or some other factors such as age.
I like eating fish like salmon (on sale) and sardines (on sale, $.99) that provides 1,380 omega-3 (label claims) per can. However, for maintenance boost I like Kirkland “Natural” fish oil that is TAG but supplies only about 180-mg EPA-TAG and 120 DHA-TAG that will get into your blood because your digestive system is use to this “natural fat”. I called the hotline on the bottle and was told (verify then trust) the product was verified by USP as the label states for “this product”.
We usually buy Kirkland (my lot #399119-01 C1 Exp. 8/17) when it is on sale at our local Costco for $7.99 for 400 capsules. If you take two a day, you will, according to the American Heart Association, meet their target value about 500 mg/day for those without heart disease. As you know, foods are fortified with EPA and DHA and it has been reported that you get about 200-300 mg/day naturally depending on your diet. So, it is possible to get 700-800 mg/day with the two Kirkland’s. In my opinion, the ethyl ester brand of the Kirkland’s enteric product is not for me. It contains the same drug products (EPA-EE, DHA-EE) that are in the FDA approved drug products. If I wanted or needed a drug, I would consult my health care provider for a prescription and not a dietary supplement with misleading labels. I am a senior citizen who practices preventive medicine and I believe that natural fish oil, i.e. oil extracted from fish, refined and purified is compatible with my first meal on my birth date.
I read that if you reduce your consumption of omega-6 products corn oil etc., you can potentially decrease inflammation if you take more omega-3. A good source of basic lay-person (my kind of language) information is the book “The Omega-3 Effect” by Sears and Sears. They even have some recipes.
For comfort, I would get an Omega-3 index value and to see what the ratio of omega-3/omega-6 to determine if you will be wasting your money on supplements. I read that overdosing on omega-3 will saturate your red blood cells and some studies have shown a plateau effect.
In my opinion, EE have saved many lives for their intended use to “intended to diagnose, treat, cure, or prevent any disease”.
Keep an eye open for some trending topics such as liposomes and emulsions that claim 600 x better absorption. For example see Coromega emulsion packets.
My thought is, it is not how much you take, but how much gets absorbed. Then, take advantage of your natural digestive system (loves TAG).
P
Chris:
Here is a link for adverse events reports for taking omega-3 acid ethyl esters that are in many mislabeled “fish oil” dietary supplements.
You can visit https://open.fda.gov/drug/event/ to see if you want to take a chance on these side effects.
And yes, there are also side effects when taking natural fish oil and when eating certain foods.
P
Chris:
Here is an interesting link (“http://www.pharmacytimes.com/news/federal-court-shuts-down-supplement-manufacturer”) to what can happen to a dietary supplement manufacturer who violates the current Dietary Supplement Good Manufacturing Practices (cGMP). Notice that one of the violations was “including failure to perform tests to verify the identity of dietary ingredients used to manufacture the supplements”.
You can read the warning letter at: http://www.fda.gov/iceci/enforcementactions/warningletters/2012/ucm299052.htm.
I wonder what company will be next. It reminds me of all those “fish oil” products that claim to be “100% Natural” that contain synthetic ingredients even though the supplement facts panel states: “Natural Fish Oil”. This applies to both rTAG (synthetic fish oil) and omega-3 fatty acid ethyl esters dietary supplements labeled as “Fish Oil”. However, the molecules in rTAG are “nature-identical” to natural un-refined and refined fish oil.
Remember, that synthetic omega-3 fatty acid ethyl esters are not “nature-identical”.
Diet first and try some canned sardines for your natural source (glycerolipids (TAGs), phospholipids) of omega-3 fatty acids.
P
Chris:
Here is an interesting article that compares the oxidation rates of TAGs and omega-3 fatty acid ethyl ester dietary supplements marketed as “fish oil” dietary supplements.
“Oxidation Rates of Triacylglycerol and Ethyl Ester Fish Oils”
J Am Oil Chem Soc (2015) 92:561–569. The author, J. C. Sullivan Ritter, is from Ascentahealth. If you can’t access the article, at least read the abstract and form your own conclusions.
With this in mind, I wonder how valid are those voluntary “Expiration Dates” on both TAG and EE omega-3 fatty acid dietary supplements. In the cGMP, if an expiration date is provided, there should be proof to back up the date.
Pixe
What about Calamari Oil???
See my previous comments on Calamari oil. If you want to know about a specific product, e-mail me at [email protected].
Pixe
Hi Chris,
How about Rosita cod liver oil? Have you done anyr eview on this please? It would be nice if you can review this .thank you
Sincerely
ivy
Read this article for information on Rosita’s products
http://www.nutraingredients.com/Regulation-Policy/Norway-warns-on-polluted-fish-oil-supplements
That article appears to indicate that cod liver oil was fine – the contaminated Rosita product mentioned is ratfish liver oil (whatever that is).
The issue is that raw, unrefined liver oils will inherently be high in contaminants. It’s the nature of the beast. They didn’t actually measure the Cod Liver Oil in their analysis, so we don’t really know, but I’m quite certain it would be similar because it’s raw.
Are you aware of a product called Omega Cure? If so, any information about it?
I had to stop taking oil capsules (flax, primrose, and especially fish and krill) because they give me reflux so bad my esophagus is swollen for months. And yes I e tried all the tricks for preventing fish burps.
My body is massively inflammatory though, despite a decent diet of mostly chicken, turkey, and salmon with leafy greens and a wide variety of other veggies, fruits and water to drink. I try to stay away from wheat, grains and gluten ( other than oatmeal), dairy (except high quality yoghurt) and processed packaged foods.
I occasionally put flax, chia or hemp in smoothies, but what other sources of O-3s and DHA could I try? Would algae derived sources work?
Walnuts and Avocados
Walnuts and Avocados are VERY high in O6’s, avoid…
Chicken is very high in O6’s, avoid…
Add in sardines in water, canned tuna in water, papaya.
Also avoid all oils except coconut oil. All oils except coconut oil are high in O6’s.
Bring down O6’s in your diet first, then work on adding in more O6’s, but don’t add in O3’s if they come with O6’s like in walnuts for example.
Both of my German boxers have sever intolerance to salmon, as well as sardines & anchovies! So how do I get fish oil into their diet without causing them GI distress?
Sounds to me, like, if your boxers are severely allergic to salmon, sardines and anchovies, chances favor their also being allergic to any marine oil, regardless the species. However, if you want to persist looking for fish oil that doesn’t make them sick, other fish species also are oily, such as mackerel, or halibut. You might research the available brands of fish oil to see if any are manufactured from one of those. Also, there is krill oil, green lipped mussel oil, and other shellfish based fish oils.
Vegetarian alternatives to fish oil include flaxseed oil and borage oil. Perhaps a vegan oil would be palatable and tolerable.
Then there is the “classic” fish oil, very rich in EPA—DHA: cod-liver oil. Cod-liver oil is a powerhouse of marine based oils, but not everyone can adjust to the strong fishy taste. Google for the best cod-liver oil brand you can find.
A fuller discussion of the merits and de-merits of cod-liver oil is Chris Kresser’s own on this website: http://chriskresser.com/separating-fact-from-fiction-on-cod-liver-oil/
The following quote is from the article: “Healthy Skeptic note: I recommend either high-vitamin cod liver oil or fermented cod liver oil from Green Pasture and Wolf River Naturals.”
Barleans is an excellent brand of flaxseed, and borage, oils.
A British web site is http://www.igennus.com. There you can choose from marine or vegetarian oil products. They are relatively expensive, but my experience with the company has been nothing but excellent
Barleans is an excellent brand of flaxseed, and borage, oils.
A British web site is http://www.igennus.com. There you can choose from marine or vegetarian oil products. They are relatively expensive, but my experience with the company has been nothing short of excellent
It might be safer to give up on fish oils altogether.
This horse supplement worked very well for my own dogs: Profile by Horse Tech ( https://horsetech.com/equine-supplements/omega-3-dha/profile).
I just finished reading Ascenta Health’s review of scientific studies concerning the differences between fish oil in TG (triglyceride) form, compared to fish oil in EE (Ethyl Ester) form. It is a lengthy article so you if you are interested in reading from beginning to end you might want to download it for offline reading.
There is a great deal of discussion, along with graphs and tables, which are illuminating if you are concerned about how fish oil in its Triglyceride (natural) form, and Ethyl Ester (distilled) form differ in chemical composition and processes, and how all that relates to absorption, and bioavailability, of EPA and DHA, plus other Omega-3s, for the two forms.
It turns out, as scientific controversies often do, that a simple answer to “which is better,” rTG (or rTAG) or Ethyl Ester, is not possible to give. There are many aspects where to differentiate the two types of fish oils, considerable data on either one.
Basically, the two types do differ, sometimes significantly so, sometimes not, and one type, the Triglyceride form fish oil appears to be distinctly superior to Ethyl Ester (including the styrofoam test PIXE has elaborated on elsewhere in this blog). Yet, over a longer period of time, two weeks or later, taking either form results in a steady state of EPA, DHA, etc., in the bloodstream, which is the end result one should be most interested in. There the two forms of fish oil are roughly equal in concentration in the blood, when taken in identical or similar amounts per day, two weeks into taking either form.
However, there are a number of other reasons why one might prefer the triglyceride form to ethyl ester, and the article enumerates and discusses those reasons.
Here is the link:
https://www.ascentahealth.com/omega-3-and-you/the-science/fish-oil-triglycerides-vs-ethyl-esters-comparative-review-metabolism-absorption-stability/
Tom:
Misbranded “fish oil” containing synthetic omega-3 fatty acid ethyl esters that dissolve polystyrene was not my idea. See “Fish Oil Urban Legend” by Ackman in Inform, September 2007, Vol. 18 (9) Page 586. I simply used polystyrene petri dishes to show the more dramatic effect of these solutions of chemical compounds used as dietary ingredients to fill capsules to sell as knockoff fish oils. You should realize that these knockoff products are not “fish oils” and they are not oils as defined in many food chemistry textbooks. Fish oil is can be classified as an edible fat and oil as defined in food chemistry textbooks along with vegetable and seed oils. They are Glycerolipids, i.e. mixtures of aclyglycerols (MAGs, DAGs, and TAGs) that are natural compounds that your digestive system has been optimized for digestion.
In my opinion, others would argue this is “irrelevant” and fatty acid ethyl ester based “fish oil” can still be sold as dietary supplements without penalty for deceiving consumers.
Fortunately Senator McCaskill is speaking up for us senior citizens when she opened an inquiry on these bogus dietary supplements.
“McCaskill also sent letters to 15 retailers inquiring about their review policies for dietary supplements and what they had done to prevent sales of harmful or fraudulently marketed products in their stores and on their websites and shows.”
See (http://www.mccaskill.senate.gov/media-center/news-releases/mccaskill-opens-inquiry-into-brain-armor-and-other-dietary-supplements-targeting-seniors)
for letters sent to FDA and retailers.
Hopefully this investigation will clear up the misbranding of the iconic “fish oil” brand so that senior citizens like myself can feel confident that the product I purchased labeled as “fish oil” actually contains the oil extracted from fish and not some substitute synthetic inferior chemical compounds.
If I wanted to purchase misbranded fish oil products, the label should clearly say “omega-3 fatty acid ethyl esters” so that I can make a choice and not have some marketer decide for me by not disclosing the true identity of the dietary supplement. By not disclosing the true identity of dietary supplements, it eliminates my freedom of choice.
Again, my argument is to put the true identity of the dietary supplement on the supplement facts panel so that consumers can decide for themselves if they want to purchase ethyl esters, TAG, or rTAG regardless of the efficacy and safety of the dietary supplement.
If you want real examples of the deception and the bait and switch tactics being used by “fish oil” marketers see http://omega-3snakeoil.com and fishoildetective.com
Pixe
“Yet, over a longer period of time, two weeks or later, taking either form results in a steady state of EPA, DHA, etc., in the bloodstream, which is the end result one should be most interested in. ”
Quite an incorrect conclusion. You need to concern yourself with the ratio of fats in your cell membrane. This is why the fallacious understanding of DHA/EPA ratios will be revamped to better illustrate homeostasis.
All the blood lab reports will yield information that will not service your needs. Look to ” Genovia Labs” to get a cellular analysis. That is the first step towards a truer understanding of Free fatty acid health that allows the cell membranes to hormonally modulate the body to its highest potential.
I have been taking wild salmon fish oil everyday since the 80’s.
I also eat fresh steamed salmon everyday.
I. should like to know your opinion of calamari oil (golden calamari oil from Health Care. It has more DHA than any of the fish and Krill oil available
What are your thoughts on this one Chris/guys?
What is that ACTUAL truth?
http://www.dailymail.co.uk/health/article-2232022/Fish-oil-pills-Youre-wasting-money-says-nutrition-expert.html
Rob,
The author makes some valid points:
1. For the vast majority of people, eating 2 servings of whole fish or shellfish per week trumps the benefits of any and all fish oil supplements, which, if they are of desirably high quality, accurately labeled, and mostly free from contaminants, are also expensive to very expensive. Bargain fish oil supplements will avail a person nothing and could well be harming more than helping one’s health.
Without getting into a debate about scientifically designed and conducted double-blind studies vs. anecdotal reports, the fact is that, yes, a number of people are helped by taking supplemental fish oil or fish oil concentrates. Even if only 5% of study subjects get measurable benefit, that means potentially 1 out of 20 individuals will benefit. Problem is, finding out if you are the 1 or among the 19 who don’t benefit significantly.
2. I definitely benefit by taking 4g-5g a day of eicosapentaenoic acid (EPA) in concentrated form, to augment medication treatment for a serious mood disorder – what used to be diagnosed bipolar disorder prior to publication of the DSM-5 diagnostic manual for medical and health professionals.
They provide a margin of additional relief for both depression and elevated mood swings, so I don’t have to continue to increase dosage on my prescribed psych meds, of which I take 5 once or twice a day. I take the prescription formula EPA only drug Vascepa, which is safe and effective, but very expensive. Fortunately I get an assist from Medicare Prescription Drug Act. I wish I could afford the dosage I take so I can pay for it myself, but for equivalent purity and high quality I would need to spend well more than $150.00 a month, which I simply cannot afford.
Another benefit I receive from taking EPA-only Vascepa is significantly reduced pain and soreness from osteo-arthritis (despite what Sanders contends that osteo arthritis is not relieved by taking fish oil concentrate. I also take 1 daily capsule of Palmitoleic Acid, aka Omega-7. In combination with EPA I have had about a 1/3 reduction in soreness and joint pain, as well as about 50% increase in joint mobility without pain. For me, anyway, I call it a miracle to experience such level of pain relief and increased mobility globally. I’m not imagining it, Omega-3 concentrated EPA, or EPA/DHA, plus concentrated Omega-7 working in tandem do unquestionably benefit me. Yet I’ve seen my doctor give me that look as if I was making it all up. Believe me, if it was as easy to make it all up, get the same results, at no cost to me, believe me I would. Other aids of course are regular exercise, working joints, and moving about in general. Diet and meditation also help pain relief.
A person does not have to take fish oil pills at all if s(he) gets a sufficient amount of whole fish in the diet. For some conditions — I forgot to mention the significant gains I get in focus and concentration which help Attention Deficit Disorder, which I also have had diagnosed — fish oil pills and concentrates might benefit but there is no guarantee they will benefit.
It is best to have one’s blood tested for concentrations of Omega-3-5-7’s naturally and while taking fish oil, to see if there are significant gains to offset a possible deficiency of Omega-3s, etc.
I want to change my %-age estimate of benefit for joint mobility, downward, from 50%, to between 25%-33.33% gain. I don’t want to overstate, the gains are modest ones, but they are highly significant to me, i.e. they make a real difference in my ability to do a whole range of household chores, walking, maintaining balance, all of which are vital concerns of mine.
“Dr.” (if indeed he is a doctor) Sanders isn’t wrong, but he also is intentionally discouraging people from trying fish oil and fish oil supplements, to see what their results might be. I would definitely recommend both eating fish and taking a supplemental fish oil pill once or twice a day. That makes the most sense to me. Your results may differ, as they tend to say at the end of commercial messages.
Rob:
The article is confusing the synthetic omega-3 fatty acid ethyl esters (not fish oil) chemical compounds with the health benefits of taking real fish oil dietary supplements.
Unfortunately, main-stream media is confused about the definition of what fish oil (CAS # 8016135) is. This has tarnished the iconic “fish oil” brand by association with a man-made chemical compound used for pharmacological purposes and not for nutritional purposes.
If you need to “diagnose, treat, cure, or prevent any disease” take the FDA approved synthetic pro-drugs omega-3 fatty acid ethyl esters (EPA-EE, CAS# 86227-47-6 and DHA-EE, CAS# 1020718-25-5 ).
In my opinion, if you need to supplement your diet because of limited access to EPA and DHA, take a nutritional supplement that is a natural marine oil, krill oil, or algae oil (TAGs). The evolution of the human digestion system is optimized to digest edible fats and oils (TAGs).
If you look at many of those meta analyses with omega-3s interventions, the majority were done with omega-3 fatty acid ethyl esters such as the FDA approved drugs Lovaza (Omacor outside the US) and Vascepa (Epadel in Japan) given to subjects who had heart disease.
There are studies that have shown a prevention affect of eating oily fish and/or taking real marine and algae oil dietary supplements on CVD and CHD. There are also other studies that show no affect.
Since senior citizens, low income, allergy to fish, geographical location, and perhaps taste may not allow consumers access to expensive oily fish like salmon. On the other hand, for about 5 – 7 cents a day, you can “pop a pill” and get similar health benefits as the affluent who can afford to eat high quality salmon or other oily fish recommended by the American Heart Association.
Pixe
Yet you recommend synthetic rTG fish oil concentrates which are even more synthetic than EE fish oils? You do realize that rTG fish oils were in the EE form before being re-esterified into the rTG form, right?
The only TRULY natural fish oils are the ones that have never had their fatty acids removed from their glycerol backbone, which precludes every fish oil concentrate on the market. Both EE and rTG “fish oils” are synthetic, and that’s perfectly fine and they should (and are) legally called “fish oils”.
Truth Seeker:
Thanks for your excellent observations.
For starters, consumers can read the reference: “Rapid in vivo hydrolysis of fatty acid ethyl esters, toxic nonoxidative ethanol metabolites” in which the monounsaturated fatty acid ethyl ester of oleic acid (CAS# 111-62-6) was fed to rats in a 1997 publication. (http://www.ncbi.nlm.nih.gov/pubmed/9252525) Oleic acid (C18:1n-9) occurs at about 5-12 wt. % in menhaden oil esterified as acylglycerols in refined oil. Similar concentrations are found in other oily fish that are extracted and purified to produce fish oils. One highlight of the study included “Thus the degradation of FAEE in the GI tract and in the blood provides an explanation for the apparent lack of toxicity of orally ingested FAEE.” You can read the rest of the article about this one fatty acid ethyl ester. If you think this 1997 article contradicts my earlier posts, stay tuned.
Pixe
I guess I am a little confused. When did I state that fish oil supplements were meant for rats? Do you have HUMAN clinical trials showing toxicity of ethyl esters? Grapes and chocolate are toxic to dogs, yet they’re safe for humans. You have to do better than that to prove your point.
And again, why are you failing to acknowledge that rTGs are synthetic?
Why did this conversation stop? I was starting to enjoy it 😉
Can anyone point me to some research on omega-3 outcomes in people with ocular stroke? Thanks!
Have you explored the testing results provided by LabDoor.com for fish oil supplements?
Has anyone else noticed that Chris has not elaborated on Carlson’s products when asked to by several people posting?
Please respond Chris.
I found this article very enlightening however they have a different view on the synthetic or re-esterified TG form to yours Chris. Would be glad to hear your comments.
http://prnomegahealth.com/wp-content/uploads/TGvsEE_English_04-05-11_review2.pdf
Lynne:
That article has many errors and statements such as “While in the EE form, the glycerol backbone is missing.
Therefore, the fatty acids will find an available triglyceride
backbone or take one from an existing molecule.” shows that the author is does not know what they are talking about.
Additional comments in the article “As we have just discussed, when ethyl esters are consumed,
they are processed in the liver, where the ethanol is drawn
off, and the body must then rebuild the resulting free fatty” is not correct.
Some parts of the article are correct about the synthesis of EE. Also, the article is old and there are more recent publications (peer reviewed) that show better absorption with TAG and in particular to emulsion based TAGs such as the clinical trials using Coromega Omega-3 emulsion. (http://www.coromega.com/about/bioavailability-clinical-study/) see article at J Am Diet Assoc. 2009; 109:1076-1081.
Pixe
Actually, the original linked article is not entirely wrong. EE bound fatty acids will be partially repackaged into triglycerides in the body. And EE fish oils do not have a glycerol backbone.
Also, most of the studies showing that TGs are vastly better absorbed than EEs are quite short in duration (30 days or less). It is known that EEs are much SLOWER to be absorbed, but that they will reach a RBC level of approximately 85% of TGs in 4-6 months. However, rTGs are more than 15% more expensive than EEs, so the cost factor is a real consideration when you can simply take 15% more EE and get the same benefit for less money.
Thanks Truth Seeker. This is very interesting.
Hi Chris, what do you make of this article advocating supercritical distilled fish oil, in favour of molecularly distilled fish oil – described here as fried fish oil that’s full of toxins: http://epicnutrients.com/blogs/news/9167903-don-t-eat-fried-food-then-why-are-you-eating-fried-fish-oil
The site sells supercritical fish oil which is a red flag I know. Do the studies of mol. distilled oil you’ve read undermine what’s being said here? I want to take fish oil for severe chronic pain. Cheers
The major producer of supercritical fish oils acquires their fish oil AFTER it has already been molecularly distilled. If anything, supercritical fish oils are even MORE refined, not less refined than molecularly distilled oils.
Anybody have any thoughts/experience with GNLD’s Salmon oil plus? or the “older” Omega III Concentrate?
Any thoughts on Metagenics OmegaGenics Mega 10 (omega 7&3 supplement). The serving size is one soft gel. My ND recommends 3 soft gels.
Does anyone have recommendations for a high quality fish oil for kids that doesn’t have anything artificial in it and kids will eat? Thanks.