New Perspective on Omega-3 Supplements

Author: Michael Bernstein

When it comes to omega-3 supplements, there’s such a vast amount of information out there, and with multiple seemingly credible sources providing different recommendations, it becomes challenging to sort it all out.  The perspective I take is that of a deficiency approach.  It’s undisputed that omega-3s, which consist of ALA, EPA, and DHA are essential nutrients, specifically essential fats, which must be obtained from diet, otherwise, a deficiency will occur.  Deficiencies include concentration and attentiveness issues, joint pain, allergies, cardiovascular concerns, fatigue, problems sleeping, among other things [1].  The best guidance is to obtain adequate omega-3s through diet rather than supplements.  The reason for this is that whole foods include the entire range of fish fats, vitamins, minerals, and supporting molecules rather than isolated ALA, EPA, and DHA [1].  There was a study that found that women who took omega-3 supplements had longer telomeres which are associated with increased health and slower pace of aging.

For obtaining omega-3s through food, many dieticians recommend eating wild-caught fish, such as salmon, twice a week.  Epidemiological studies have shown a strong correlation between fish consumption and reduced risk of heart attack [4].  For individuals that don’t like fish, or are intent on maintaining vegetarian/vegan diets, there are other options available.  There are algae-based omega-3 supplements, but from my experience, they usually don’t raise omega-3 blood levels of EPA and DHA to satisfactory levels.  However, by combining them with flax seeds, individuals might be able to approach sufficient levels.  It should be noted that algae only contains EPA and DHA, and does not contain ALA.  Flax seeds, and other nuts and seeds, only contain ALA.  The body converts ALA into EPA and DHA, but the conversion process does not work that well in many people.  Dr. Greger, author of How Not To Die, a New York Times best-seller, advises individuals to consume flaxseeds and/or 1 serving of nuts and seeds daily [7].  Flaxseeds are one of the best sources of omega-3 ALA, and I recommend consuming 3 tablespoons of ground flaxseed per day, aligning with Dr Greger’s recommendation [7].  One teaspoon certainly won’t cut it.  It can be mixed in yogurt or a smoothie.  Flaxseed, when combined with an algae-based omega-3 supplement, might help individuals approach sufficient levels of omega-3s, but only if the body can convert enough of the ALA to EPA and DHA.

There is a pharmaceutical medication available called Vascepa.  It’s derived from omega-3 fish oil, and it only contains EPA.  It doesn’t have any ALA or DHA.  The reason this medication doesn’t include DHA might be because there’s some data that indicates that DHA can raise LDL cholesterol, which is associated with worse health outcomes.  The body will convert EPA to DHA, but only to a limited extent [3].  Vascepa is approved by the FDA for people with high triglycerides and diabetes [5].

I think that Vascepa excluding DHA from its formulation may not be a good idea.  This is because DHA is an essential component of omega-3s and is required for maintenance of normal brain function in adults.  The brain takes up DHA in preference over other fatty acids, which highlights its importance.  DHA deficiencies in adults include deficits in learning, cognitive decline, major depression, and Alzheimer’s disease. DHA deficiencies in infants include learning disabilities, ADHD, depression, and other illnesses.  There was also a study published in the journal Nutrients that showed that individuals with higher levels of DHA in their blood were 49% less likely to develop Alzheimer’s [6].  Having adequate DHA also has positive effects on hypertension, arthritis, atherosclerosis, depression, type 2 diabetes, heart attack risk, and some cancers.  Based on this, I think it’s important not to exclude DHA when it comes to omega-3s [4].

To sum it up, my recommendations are for people to eat fish one or two times a week, or take fish oil supplements containing EPA and DHA.  If you have high LDL and are concerned about DHA, Vascepa may be a good option, and this should be discussed with your doctor.  Vegetarians and vegans can take algae supplements and ground flaxseed.

If you choose take a fish oil supplement, select a brand with high purity that rids the oil of contaminants, such as mercury and PCBs.  Also, if you want to have your omega-3 levels checked, there’s an Omega-3 Index that can be included with lab work that checks for EPA and DHA.

REFERENCES

1. https://www.camasmedical.com/2019/03/13/omega-3-deficiency-symptoms/
2. https://www.health.harvard.edu/blog/fish-oil-friend-or-foe-201307126467
3. https://www.health.harvard.edu/blog/omega-3-fatty-acids-and-the-heart-new-evidence-more-questions-2021032422213
4. https://pubmed.ncbi.nlm.nih.gov/10479465/
5. https://diatribe.org/vascepa-prescription-omega-3-fatty-acid-shows-heart-health-benefits-high-risk-populations
6. https://neurosciencenews.com/omega-3-dha-alzheimers-20796/
7. Greger, M.  How Not to Die.  Flatiron Books.  2015.

* The content provided by this article is for informational purposes only.  These statements are not intended to diagnose, treat, cure, or prevent any disease.  This article is not intended to provide personal medical advice, which should be obtained from a medical professional.