Fish Oil Quick Reference

Contents

• Overall context for this topic
• General information
• Program target
• Cautions
• Supplement considerations
• Product suggestions
• Testing considerations

Page edition: 2018-08-08

Context

Omega 3 DHA and EPA, almost always from fish oil, is a core program supplement. Unless you consume ancestral amounts and forms of wild-caught seafood and/or game organ meats, your Omega 3 levels, of these particular fatty acids, are very likely suboptimal.

There are at least 11 Omega 3 (ω3) fatty acids found in nature. Of these, only three are significant food-source Omega 3s:
DHA: Docosahexaenoic acid
EPA: Eicosapentaenoic acid
ALA: alpha-Linolenic acid⇱ Return to ToC

General Information

The need for DHA and EPA from fish oil has been part of the program, going back at least a decade, and is extensively discussed in all the books and program materials:
Book: Undoctored: starting page 287 of the print edition
Video: Are you consuming enough omega-3 fatty acids? (public)
Video: Physiological Benefits of Omega-3s (members)
Video: What If You Don’t Like Fish Oil? (members)

The "fish oil" nomenclature is no accident. The principal (economic) source of DHA and EPA is from fish. Ancestrally, eating enough seafood to meet ω3 needs was fine. Modern ocean toxins make that unwise. Ancestrally, humans would also have gotten these ω3s from game organ meats (and game brains), but modern humans, eschew those sources.

ALA is widely available from plant sources, and humans do convert a small percentage of it to DHA and EPA, but not enough, and consuming excess ALA reportedly drives conversion down (and may have independent health risks). There is generally no need to supplement ALA.⇱ Return to ToC

Program Fish Oil Targets

Intake targets:
Generally: 3000 to 3600 mg/day of DHA+EPA
With elevated Lp(a): 6000 mg/day
High seafood intake: adjust supplementation per test results
Divide the daily amount into 2 or 3 doses.

This is milligrams of DHA plus EPA, and not the total amount of fish oil (which will be higher). The ratio of DHA:EPA may be anywhere between 1:2 and 2:1, or put another way, make sure you get the total, and at least 1000 mg of each. For comparison, this is about how much fish oil is present in 3 small cans of sardines.

Titer targets:
The actual DHA+EPA goal is for blood levels of Omega 3 to be 10% of fatty acids, and for Omega 6 levels to be no more than twice that. See Testing considerations below for further information.

Non-coincidentally, the program’s standard dose of DHA+EPA is in the same range as for the preposterous prescription forms of fish oil (Lovaza®, Omacor®, Omtryg™ and Vascepa®).

For anyone avoiding fish for any reason, DHA and EPA are available from processing of marine algae (the same place the fish get it), and, from time to time, via industrial fermentation. These sources, although often costly, and obviously not ancestral, can meet program requirements.

Dose timing
Split the daily fish oil dose into two or three portions, taken across the day. If taking part of that as a fish oil+D3, take the D3 variant in the morning.

Take fish oil while fasting?
That depends on the reason for the fast. Fish oil is 3.6 grams of fat, or 32 calories. Being a fat, however, it would be no threat to ketosis.⇱ Return to ToC

Cautions

On a statin?
There is an interference between statin drugs and fish oil benefits. Dr. Davis wrote about this in a 2013 (then TYP) Blog post:
Are statins and omega-3s incompatible?
In addition to the paper linked there, here’s a later one:
NMCD: Intake of polyunsaturated fat in relation to mortality among statin users and non-users in the Southern Community Cohort Study

Fish Allergy?
Anyone with an unresolved fish allergy, or anaphylactic reaction to fish or shellfish, needs to approach fish oil carefully. In that situation, using a vegetarian source of DHA+EPA might be the interim solution, but it could actually be more costly than the co-pay for using one of the highly-processed prescription fish oils. The prescription oils are still fish-sourced, so being hypo-allergenic reaction is not assured. Getting that prescription is another matter.⇱ Return to ToC

Supplement considerations

Blood thinning speculations
Site members are directed to this remark by Dr. Davis from 2008. The prescription forms of fish oil these days merely suggest monitoring, where anticoagulant agents are in use. Such papers as exist cautioning about fish oil tend to be confounded by statin use (perhaps unrecorded), adverse wider diet, and med interactions.

Mega-dose fish oil?
Nothing in the program today suggests consuming more than 6 grams per day. Much higher doses are being used experimentally in certain situations, such as TBI, but chronic uses of mega-doses is basically unexplored territory.

Supplement form
Gelcaps or bottled liquid oil are suggested. With capsules, seek the highest potency per capsule (not necessarily per “serving”), to keep the capsule count manageable. Favor the triglyceride form of fish oil over the ethyl ester form, depending on other priorities. Be cautious about products containing anything other than fish oil and seek grain-free encapsulation. Added vitamin D can be valuable, but mind the IUs.⇱ Return to ToC

Product suggestions

This is not an exhaustive list. Other available products are satisfactory. Typical price for 3.6g/day is shown parenthetically.

Triglyceride forms

Carlson 500 mL Liquid (US95¢/day)

Nordic Naturals Ultimate Omega (650 mg/cap ω3, US$1.83/day)

Nordic Naturals Omega 3 (liquid) (14.4 mL for 3600 mg ω3, US$1.19/day)

Nutrigold Triple Strength (1000 mg/cap ω3, US$1.07/day)

Ascenta NutraSea Liquid (14.4 mL for 3600 mg ω3, US$1.10/day)

Ethyl ester (or unstated) forms

Natural Factors Ultra Strength RxOmega-3 (900 mg/cap ω3, US$1.06/day)

Trader Joe’s Omega-3 Fatty Acids (600 mg/cap ω3, US89¢/day)

Member’s Mark Triple Strength (900 mg/cap ω3, US53¢/day)

Member’s Mark Double Strength w/D3 (650 mg/cap ω3, note)

Note: the MM Double Strength product provides 2000 IU D3 per capsule, and typically can’t be used as the sole source of fish oil, as that would be 11,000 IU of D3 per day. 1-3 of these in the AM, and the balance as the Triple Strength product can work. Run these numbers for any fish oil with/D, as other brands can present the same issue.

Beyond those products, you may want to rely on third party product evaluations. Subscription site ConsumerLab tests fish oil periodically. Industry site IFOS has open-access test data available, but doesn’t really rate products, and only reports on member products.

Avoid krill-based products on economy grounds (just run the numbers some time). Avoid cod liver oil due to excess vitamin A and marine toxins. Fish oil incidentally includes fatty acids other than DHA and EPA, but avoid anything that is mostly ALA (such as added flaxseed oil). Avoid anything with added Omega 6 (adverse). Avoid anything with added Omega 9 (needless).

Store fish oil in a cool location out of direct sun exposure. Refrigeration is fine.⇱ Return to ToC

Testing considerations

If in doubt about fatty acid status, or needing to dial-in supplementation due to high seafood intake, two tests can be useful. These are the most accurate when weight has been stable for 30 days or more. If you are losing weight, that includes a lot of stored fat — fat which may represent prior diet (and is apt to be low in ω3 and high in ω6).

Test details

If these tests aren’t routinely covered by your carrier (and they probably aren’t), it’s often cheaper to obtain them on your own, nanny state permitting, from a mail-order or walk-in lab, perhaps via a Omega-3 Index Plus Finger Stick Test (LC100065, US$79-105) or Omega-3 Index Complete Finger Stick Test (LC100066, US$79-105).

Test day considerations

Fasting status: Avoid fish oil 12 hours before test.
Other supplements/meds: may be taken before or after draw
Time of day for test: anytime
Re-Test timing: wait 3-4 months⇱  Return to ToC