The Truth About Fish Oil Supplements
Omega-3 fatty acids are healthy fats that are essential for good health, and since our body doesn’t make them, we have to get them from other sources. Everyone from medical doctors and dietitians, to naturopaths, alternative-medicine doctors, and even the supplement industry, agrees on this fact. And all of them (except maybe the supplement industry) agree that the best way to get omega-3s is from eating fatty fish, like salmon and tuna.
But it’s not always easy to eat fish regularly, which is why fish oil supplements have become a popular alternative for people who want to make sure they’re getting enough of these important fats. Whether or not they’re a sufficient alternative, though, is questionable. While more studies need to be done, science so far suggests that fish oil may not be all it’s cracked up to be. Here’s what you need to know about the supplement, and how you can get enough omega-3s without choking down a massive pill.
First, let’s look at why people are popping fish oil pills in the first place.
Omega-3 fatty acids are essential healthy fats that we need for good health. They’re particularly beneficial for the heart, working to lower LDL cholesterol, and also contribute to brain function and proper cell growth. We must get omega-3 fats from outside sources, because our bodies cannot make them in the way we can make other fats.
It’s natural people would go for fish oil supplements for omega-3. It’s a lot easier than cooking a filet every night. But the research doesn’t clearly show that you get the same benefit from fish oil that you do from fish.
A recent study in the Journal of the American Medical Association study found that of 18 randomized clinical trials (the gold-standard of medical studies) looking at fish oil use, only two demonstrated any positive health benefits, specifically relating to cardiovascular, neurocognitive, ophthalmic, and inflammatory disorders. The remaining 16 studies did not demonstrate any benefit or proof of efficacy.
What’s more, this same study found that the vast majority of people who take fish oil supplements do so without explicit instruction from their medical provider. Basically, most people just take fish oil supplements because they believe they are beneficial.
Fish oil seems to have benefits, but the amount needed is probably way more than we think—and way more than anyone will realistically take.
The American Heart Association recently found that patients taking a daily 4-gram dose of omega-3 fatty acids from fish oil fared better after a heart attack than those taking a placebo. Their findings showed that “omega-3 fatty acids are a safe and effective treatment in improving cardiac [health], and may be promising in reducing the incidence of heart failure or death.”
Of course we all want to be healthy and reduce our risk for heart attack, stroke, and death, but 4 grams of omega-3 fats from fish oil pills is hard to stomach, even for the hardiest of us. A typical fish oil supplement or pill has between 400 and 1,200 mg of fish oil. Of that, one-third to one-half (roughly 400-600 mg per pill) may be the good-for-you omega-3 fats (eicosapentaeonic acid (EPA) and docosahexaneoic acid (DHA)) we hear about. In order to get 4 grams of omega-3 fatty acids from fish oil, you would need to consume at least eight pills each day. P.S., they also happen to be completely enormous.
That level of fish oil intake may lead to a number of unwanted and uncomfortable side effects including belching, bad breath, heartburn, nausea, loose stools, and nosebleeds, making this regimen extremely difficult to comply with. Even the recommended daily amount gives a lot of people a queasy stomach and stinky breath, which is why there are pills out there marketed as having no fishy aftertaste.
In fact, Ilan Kedan M.D., M.P.H., division chief of cardiology for the Cedars Sinai Medical Center in Los Angeles, tells SELF he generally does not recommend fish oil to his cardiac patients because, “there is no convincing data suggesting effectiveness at these lower doses.” (Most cardiac patients take 2,000 mg (2 grams) per day of fish oil; less than the 4 grams per day recommended in the study.) Not only that, but Kedan says fish oil “is just more pills that patients have to remember to take each day,” and these patients are “already taking several pills.” The juice doesn’t really seem worth the squeeze.
Another potential concern with fish oil is what else we might be getting when we consume it.
There is a lot of plastic debris floating in our oceans, and fish and other marine creatures eat some of the very tiny plastic particles. Toxic chemicals attached to the plastic such as PCBs, BPA, DDT, and others end up in the fish, stored in their fat, and may eventually end up in us. (I have written about this extensively in “Plastic: it’s what’s for dinner.”)
The bottom line: Eat fish, skip the horse pills.
Marion Nestle, Ph.D., M.P.H., the Paulette Goddard Professor of Nutrition, Food Studies, and Public Health at New York University, tells SELF, “Most of the evidence for the benefits of omega-3s come from studies of fish consumption,” such as the Mediterranean diet where fairly high levels of fatty fish are regularly consumed. Nestle goes on to say, “The evidence from supplement studies is decidedly mixed,” and when it comes to fish oil, current intake levels may not be terribly effective.
Not into seafood? Vegan? You can get omega-3s from plants, too.
We need omega-3 fats for good health, and can only get them from food or supplements, but if you don’t eat fish, there are other places to get them. Alpha linolenic acid is a fatty acid that comes from plants, and our bodies can convert this into the other forms of omega-3, DHA and EPA. However, some evidence shows it doesn’t do so very efficiently. Getting sufficient ALA from things like walnuts, olive oil, and flaxseed is good, but we can’t rely on the body’s conversion process to get all the EPA and DHA we need. That’s where the one vegan source of these fats comes in: algae.
Algal oils are a terrific source of plant-based DHA, are where fish obtain their DHA, and do not carry the same risk of contamination as fish oil since they are at the bottom of the food chain. Algal oils do not appear to exhibit the reported side effects of fish oils and have been used in food products such as infant formula for years. Find an algae supplement or oil that contains both DHA and EPA to reap the biggest benefits.
“Like so much else in nutrition,” Nestle says, “the advice boils down to ‘eat your veggies.’” In this case, that veggie just happens to come from the bottom of the ocean.