Fish Oil

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Fish oils, also known as marine oils, are essential fatty acids (lipids) found in fish, particularly cold water fish, and other marine life such as phytoplankton. These oils are rich sources of long-chain polyunsaturated fatty acids (LCPUFA) of the n-3 (omega-3) type. The two most studied fish oil fatty acids are the 20 carbon eicosapentaenoic acid (EPA) and the 22-carbon docosahexaenoic acid (DHA). Following ingestion EPA and DHA are transported by the circulatory system to various tissues of the body where they are used mainly for the synthesis of phospholipids. These phopholipids in turn are incorporated into the cell membranes of blood platelets, blood cells and central nervous system cells, as well as many others. DHA, in particular, is a vital component of the phospholipids which make up the cellular membranes of the brain and retina.

Most fish oil supplements are about 20% EPA and 10% DHA, or a total of 30% omega-3. These omega-3 fatty acids, unlike the omega-3 fatty acid found in flaxseed oil and other vegetable oils, help to keep blood triglycerides in check and may protect against atherosclerosis.

Suggested Health Benefits of Fish Oil Supplementation

Fish oils may primarily be indicated to lower triglyceride levels in those with hypertriglyceridemia. Another important indication may be to prevent death in those who have suffered myocardial infarctions. However, studies indicate that fish oil supplementation may be valuable in preventing a number of conditions including the following:

• Crohn's disease. Fish oil may help to prevent relapse in Crohn's disease. The results of one double-blind trial of individuals with Crohn's disease showed that subjects taking fish oil experienced a significantly reduced relapse rate. The fish oil used in this trial was enterically coated free fatty acid form that provided .9 grams of DHA and 1.8 grams of EPA daily. No adverse side effects were reported.
• High blood pressure. Fish oil supplementation may be useful for lowering blood pressure. Analysis of 17 controlled studies indicated that supplementation with at least 3 grams of fish oil daily can lead to clinically relevant reductions in systolic and diastolic blood pressure in individuals with untreated hypertension. Doses in these trials ranged from 1 to 15 grams of EPA and DHA.
• High triglycerides. In one double-blind study 234 men were randomly selected and divided into three groups. Each group was given 3.8 grams daily of EPA, in the form of ethyl ester, 3.6 grams daily of DHA, in the form of ethyl ester or a placebo. When compared to the placebo group triglyceride levels decreased by 26% in the DHA group and over 20% in the EPA group. However, the effect of fish oil on LDL ("bad") cholesterol varies, and in some people, fish oil supplementation has been reported to increase LDL levels.
• Rheumatoid arthritis. Some people with rheumatoid arthritis have been found to have lower than normal levels of fish oil containing omega-3 fatty acids in the fluid and blood in their joints. Studies have shown that EPA and DHA, like those found in fish oil, help to inhibit the synthesis of the inflammatory cytokines TNF (tumor necrosis factor)-alpha and IL(interleukin)-1 beta in both healthy individuals and those with rheumatoid arthritis. It has been reported that daily supplementation with 3 grams of EPA and DHA mixtures for three months or longer may reduce the number of tender joints and severity of morning sickness in individuals with rheumatoid arthritis. It has also been reported that Individuals with rheumatoid arthritis that supplemented with EPA and DHA mixtures have been able lower their reliance anti-inflammatory drugs or disease-modifying anti-rheumatic drugs.

While studies have not produced enough evidence to support their efficacy, fish oils may also be useful for:

• Asthma
• Atherosclerosis
• Bipolar disorder
• Breast-feeding support
• Cardiac arrhythmia
• Cystic fibrosis (EPA)
• Depression
• Eczema
• Heart attack
• Immune function (omega-3 fatty acids for critically ill and post surgery patients only)
• Kidney disease
• Lupus
• Osteoporosis (in combination with evening primrose oil)
• Phenylketonuria (if deficient in polyunsaturated fatty acids)
• Pre- and post-surgery health
• Psoriasis
• Raynaud's disease
• Schizophrenia
• Sickle cell anemia
• Ulcerative colitis

Fish Oil Dosage and Administration

Natural fish oil is the most common form of fish oil usually produced from the body of cold-water fish. These fish oils are, typically, 30% EPA and DHA with a ratio of EPA to DHA of 1.5. A typical 1 gram soft gel capsule of fish oil contains 180 milligrams of EPA and 120 milligrams of DHA. Natural EPA and DHA are chemically triacylglycerols. Natural fish oil capsules containing 50% EPA and DHA in a 1.5 ratio are now available. Some natural fish oil supplements contain EPA and DHA in a higher ratio, i.e. higher EPA. There are also fish oil supplements with a lower ratio, i.e. higher DHA.

Enteric coated EPA and DHA as the free fatty acids are also available. These capsules are more concentrated in EPA and DHA. Certain enteral supplements contain EPA and DHA as well as other immune-modulating nutrients such as L-arginine, L-glutamine, and RNA.

The usual oral dose of fish oil for use in hypertriglyceridemia is about 5 grams of combined EPA/DHA daily. The values expressed in this section refer to the amounts of EPA plus DHA. The actual weight of the capsule is typically much higher. Labels should be checked in order to determine the actual EPA/DHA content. The daily intake should be taken in divided doses; the supplements are best tolerated with meals. The usual dose for hypertensives that have not previously been medicated is about 3 grams of EPA/DHA daily. About 3 grams daily is also the usual dose for those with rheumatoid arthritis, Crohn's disease, and ulcerative colitis. Those who have had successful angioplasty and are trying to prevent restenosis might use 4 to 5 grams daily. Based on the GISSI-Prevenzione trial, a dose of 1 gram daily of EPA and DHA might have protective value for those who have had an MI.

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