Are Some Omega-3 Fish Oil Supplements Better Than Others?

Written by Dr. Steve Chaney on . Posted in current health articles, Omega-3 Fish Oil Supplements

Author: Dr. Stephen Chaney

truth about omega-3 fish oil supplementThe ethyl ester form of omega-3 fatty acids from fish oil has been the industry standard for high purity omega-3 fish oil supplements for many years. It is very stable, easily purified, and well absorbed by the body. What’s not to like?

If you believe some recent advertisements, there is a lot not to like about the ethyl ester form of omega-3s. These ads each claim that their particular form of omega-3s is more natural, better absorbed, and more efficiently incorporated into cell membranes, or some combination of those features. They each cite clinical studies “proving” that their products are superior. These advertisements seem so plausible and so compelling.

However, most of these advertisements come from relatively new companies that are trying to make a name for themselves in a very profitable and competitive product niche. Are the advertisements true, or is it all just smoke and mirrors? Most of these advertisements rate at least one Pinocchio.

However, it is almost impossible to tell you why I consider these advertisements omega-3 fish oil supplements to be misleading without getting a little “techie”, so let’s start with some basic definitions. I call this section “Omega-3s 101.”

 

Omega-3s 101

 

Let’s start with some basic definitions:

  • Free fatty acids (FFA) are long chain hydrocarbons with a single acid group at the end. They are only slightly water soluble. They are important intermediates in metabolism, but they are almost always combined with something else in the body.
  • Saturated fatty acids contain no double bonds, monounsaturated fatty acids contain one double bond, and polyunsaturated fatty acids contain multiple double bonds. The number of double bonds primarily affects whether they are liquids (polyunsaturated) or solids (saturated) at room temperature.
  • omega-3 fatty acidsThere are two classes of polyunsaturated fatty acids that are essential because the body cannot make them. Those with a double bond 3 carbons from the end are called omega-3s(If you think about the Greek alphabet, omega is at the end). Those with a double bond 6 carbons from the end are called omega-6s.
  • When 3 fatty acids are combined with a single molecule of glycerol they form very water insoluble compounds commonly referred to as fats or triglycerides. The proper chemical name is triacylglycerol, which is abbreviated TAG.
  • If one of the fatty acids on the glycerol chain is replaced by a compound containing phosphate and other charged residues, the resulting complex is called a phospholipid (PL). Because these compounds have a hydrocarbon surface that is attracted to fats and a highly charged surface that is attracted to water, they are good at emulsifying fats and are an important part of membrane structure. One phospholipid that is a major component of membranes is called phosphatidylcholine (PC), also known as lecithin.

Next, let’s look at how omega-3 fatty acids are metabolized:

  • The omega-3s in fish oil are primarily in the form of triglycerides, with small amounts of phospholipids. The omega-3s in most omega-3 supplements are in the form of ethyl esters for the reasons stated above.
  • Before the omega-3s leave the intestine they are hydrolyzed to free fatty acids.
  • In the cells that line the intestine the omega-3s are reconverted back into triglycerides and phospholipids and incorporated into special lipid-protein complexes for transport through the blood.
  • Once these lipid-protein complexes reach our cells, their contents are delivered to the cell where they can be stored as fat (TAG), used for energy (FFA), or incorporated into membranes (PL). It is primarily the omega-3s incorporated in cellular membranes that are thought to be responsible for the beneficial effects of omega-3s.

Finally, we should ask how one measures the bioavailability of the various forms of omega-3s:

While there are some nuances that I did not cover, the basic mechanisms of absorption and metabolism of omega-3s are remarkably similar regardless of whether they start out in the ethyl ester, triglyceride, phospholipid, or free fatty acid form. The questions then become, how does one test how efficiently the various forms are utilized by the body and how much do these individual test actually tell us?

  • When we look at what happens in the bloodstream, we need to be aware that we are looking at a combination of two effects – how rapidly the substance enters the bloodstream and how rapidly it leaves from the bloodstream. There are three important parameters we can measure when looking at delivery of omega-3s to the bloodstream:
    • The maximum concentration achieved (Cmax)
    • How rapidly that maximum concentration was achieved (Tmax)
    • The total amount in the bloodstream over time (AUC)
  • When you look at some of the ads touting specialized forms of omega-3s, they are usually based on studies looking at either the maximum levels of omega-3s in the bloodstream (Cmax) or how rapidly those maximum levels were achieved (Tmax). (One suspects the ads may have selectively featured whichever parameter made their product look best). However, the parameter that really matters is the total concentration of omega-3s achieved over time (AUC).
  • Finally, the most important question is how much of the omega-3 is actually incorporated into cellular membranes. Once again, there is more than one parameter that can be measured.
  • One can measure the level of omega-3s found in cellular membranes in a short term study (a few hours) or in a long term study following many weeks of supplementation.
  • The short term studies only measure the rate of incorporation. The long term studies measure the steady state levels attained over time, which is a much more relevant measure.
  • Once again, the ads touting specialized products are usually based on short term studies which are really measuring an initial rate of incorporation of omega-3s into cellular membranes, not on long term studies that measure the steady state level of omega-3s achieved over time.

 

Are Some Omega-3 Fish Oil Supplements Better Than Others?

omega-3 fish oil supplementThere has been a lot of confusion in the literature about whether the form of omega-3 supplements matters. Various studies have been published supporting the superiority of one form or another of omega-3s. Most of these studies have been supported by manufacturers who have a particular form of omega-3s they want to sell, and, as I mentioned above, the parameters tested seem to have been selected to make their supplement look good.  So, are some omega-3 fish oil supplements better than others?

 

Finally, someone has designed a comprehensive study to clear up all the confusion and provide answers that can be trusted (West et al, British Journal of Nutrition, 116: 788-797, 2016). Interestingly, this research was supported by a pharmaceutical company (Vifor Pharma) that does not appear to sell an omega-3 product currently. Perhaps they simply wanted to find out what worked best before designing their own product. What a novel concept!

The authors tested 4 different forms of omega-3 fish oil supplements:

  • Unmodified fish oil containing the omega-3s primarily in triglyceride form (uTAG).
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids (FFA).
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids and converted back to triglycerides (TAG)
  • An omega-3 supplement in which the omega-3s in the fish oil had been hydrolyzed to free fatty acids and converted to ethyl esters (EE)

All 4 supplements contained 1.1 grams of EPA and 0.37 grams of DHA.

The authors conducted two studies:

  • One was a cross-over study where healthy men consumed each of the supplements in random order on different days with 14 days between tests. Blood samples were collected over the next 6 hours and levels of EPA and DHA in the blood and cellular membranes was determined.
  • The other was a long term study in which a randomized group of healthy men and women consumed one of the supplements for 12-weeks and incorporation of the EPA and DHA into cellular membranes was measured.

The results were pretty clear cut:

  • In the short term study there were no significant differences between the various supplements in the rate of uptake, maximum concentration achieved, or the total concentration over time when uptake of omega-3s into plasma triglycerides and phospholipids was measured.
  • The ethyl ester form was less efficiently incorporated into plasma free fatty acids than the other forms as reported in some previous studies, but this is perhaps the least important parameter measured, and there was large variability from subject to subject.
  • In the long term study, no significant differences were seen between the various supplements in omega-3 incorporation into cellular membranes.

The authors concluded: “Together, these findings show that in healthy individuals neither the lipid structure nor the overall fatty acid composition of supplements influence their bioavailability during dietary supplementation, despite the apparent lower postprandial availability [in short term studies] of EPA + DHA ethyl esters compared with triglycerides or free fatty acids.”

What Do These Studies Mean For You?

You can forget all those ads hyping the newest, greatest form of omega-3 fish oil supplements. Objective research has shown there is not a dimes worth of difference between the various forms of omega-3 supplements.

A far more important question is the purity of the omega-3 supplement you are using. Purity of omega-3 supplements is a huge issue. You need to remember that the EPA + DHA supplements you purchase come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

Sustainability is also an issue, so you should choose manufacturers who source their omega-3s in a sustainable manner. There are two comments I will make about sustainability so you won’t be misled.

  • Krill oil is marketed as a more sustainable source of omega-3s. Krill reserves are quite large, but they are not infinite. Krill is also the very foundation of the food chain that supports a large percentage of our ocean’s fish. We need to be very cautious about depleting our krill reserves.
  • Omega-3s derived from algae are also marketed as a more sustainable source of omega-3s. Algae-derived omega-3s have purity issues of their own, but may become an important source of omega-3s once those issues have been resolved.

 

The Bottom Line

  • The ethyl ester form of omega-3 fatty acids from fish oil has been the industry standard for high purity fish oil supplements for many years. It is very stable, easily purified, and well absorbed by the body.
  • However, in recent years, some manufacturers have been claiming that their omega-3 fish oil supplements were better utilized by the body because their supplements contained the omega-3s in triglyceride or free fatty acid forms.
  • Unfortunately, the clinical studies supporting those claims have been supported by the manufacturers making the products. There is reason to suspect that the data has been “cherry picked” to support the conclusions that support the manufacturer’s claims.
  • Finally, an independent and comprehensive study has compared the various forms of omega-3 fatty acids. It found that neither the lipid structure nor the overall fatty acid composition of omega-3 supplements influenced their bioavailability during long term dietary supplementation.
  • A far more important question is the purity of the omega-3 supplement you are using. Purity of omega-3 supplements is a huge issue. You need to remember that the EPA + DHA supplements you purchase come from polluted fish. Unfortunately, many manufacturers have inadequate purification and quality control standards. In other words, neither you nor they know whether their omega-3 products are pure. You need to make sure that the omega-3 supplement you purchase is made by a manufacturer with stringent quality control standards.

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Comments (1)

  • Peggy Shearin

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    very, very interesting..

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Latest Article

Should You Avoid Sugar Completely?

Posted October 24, 2017 by Dr. Steve Chaney

Is It The Sugar, Or Is It The Food?

Author: Dr. Stephen Chaney

 

Should we avoid sugar completely?  Almost every expert agrees that Americans should cut down on the amount of sugar we are consuming. However, for some people this has become a “sugar phobia”. They have sworn that “sugar shall never touch their lips”. Not only do they avoid sugar sweetened sodas and junk food, but they also have become avid label readers. They scour the label of every food they see and reject foods they find any form of sugar listed as an ingredient. Is this degree of sugar avoidance justified?

 

Should We Avoid Sugar to Keep it From Killing Us?

 

Let me add some perspective:

  • If you just take studies about the dangers of sugar at face value, sugar does, indeed, look dangerous. Excess sugar consumption is associated with increased risk of obesity, diabetes, and heart disease. However, when you look a little closer, you find that most of these studies have been done by looking at the correlation of each of these conditions with sugar sweetened beverage consumption (sodas and fruit juices).

A few studies have looked at the correlation of obesity and disease with total “added sugar” consumption. However, 71.6% of added sugar in the American diet comes from sugar sweetened beverages and junk food. None of the studies have looked at the sugar from healthy foods like fruits, vegetables, and whole grains. That’s because there is ample evidence that these foods decrease the risk of obesity, diabetes, and heart disease.

  • For example, if apples had a nutrition label, it would list 16 grams of sugar in a medium 80 calorie apple, which corresponds to about 80% of the calories in that apple. The sugar in an apple is about the same proportion of fructose and glucose found in high fructose corn syrup. Apples are not unique. The nutrition label would read about the same on most other fruits. Does that mean you should avoid sugar from all fruits? I think not.

Avoid Sugar or Avoid Certain Foods

 

avoid sugar from junk foodsThe obvious question is: “Why are the same sugars, in about the same amounts, unhealthy in sodas and healthy in fruits?” Let’s go back to those studies I just mentioned—the ones that are often used to vilify sugars. They are all association studies, the association of sugar intake with obesity and various diseases.

The weakness of association studies is the association could be with something else that is tightly correlated with the variable (sugar intake) that you are measuring. Could it be the food that is the problem, not the sugar?

If we look at healthy foods (fruits, vegetables, whole grains) they are chock full of vitamins, minerals, phytonutrients, fiber, and (sometimes) protein. Fiber and protein slow the absorption of sugar into the bloodstream. As a result, blood sugar levels rise slowly and are sustained at relatively low levels for a substantial period of time.

In sodas there is nothing to slow the absorption of blood sugar. You get rapid rise in blood sugar followed by an equally rapid fall. The same is true of junk foods consisting primarily of sugar, refined flour and/or fat.  Avoid sugar from those types of foods.

Another consideration is something called caloric density. Here is a simple analogy. I used to explain the concept of caloric density to medical students in my teaching days. There are about the same number of calories in a 2-ounce candy bar and a pound of apples (around 278 in the 2-ounce candy bar and 237 in a pound of apples). You can eat a 2-ounce candy bar and still be hungry. If you eat a pound of apples you are done for a while. In this example, the 2-ounce candy bar had a high caloric density (a lot of calories in a small package). Perhaps a more familiar terminology would be the candy bar was just empty calories.

Are Sodas and Junk Foods Killing Us?

avoid sugar from candyPutting all that together, you can start to understand why the foods the sugars are in are more important than the sugars themselves. When you consume sugars in the form of sugar sweetened beverages or sugary junk foods, your appetite increases. We don’t know for sure whether it is the intense sweetness of those foods, the rapid increase and fall in blood sugar, or the high caloric density (lots of calories ina small package) that makes us hungrier. It doesn’t matter. We crave more food, and it isn’t usually fruits, vegetables, and complex carbohydrates we crave. It’s more junk. That sets in motion a predictable sequence of events.

  • We overeat. Those excess calories are stored as fat and we become obese. [Note: The low carb enthusiasts will tell you our fat stores come from carbohydrates alone. That is incorrect. All excess calories, whether from protein, fat, or carbohydrate, are stored as fat.]
  • It’s not just the fat you can see (belly fat) that is the problem. Some of that fat builds up in our liver and muscles. This sets up an unfortunate sequence of metabolic events.
  • The fat stores release inflammatory cytokines into our bloodstream. That causes inflammation. Inflammation increases the risk of many diseases including heart disease and cancer.
  • The fat stores also cause our cells to become resistant to insulin. That reduces the ability of our cells to take up glucose, which leads to hyperglycemia and type 2 diabetes. [Note: The low carb enthusiasts will tell you carbohydrates cause type 2 diabetes. That is also incorrect. It is our fat stores that cause insulin resistance and type 2 diabetes. Our fat stores come from all excess calories, not just excess calories from carbohydrates.]
  • Insulin resistance also causes the liver to overproduce cholesterol and triglycerides and pump them into the bloodstream. That increases the risk of heart disease.
  • Sugar sweetened beverages and sugary junk foods also displace healthier foods from our diet. That leads to potential nutrient shortfalls that can increase our risk of many diseases.

However, none of this has to happen. The one thing that every successful diet has in common is the elimination of sodas, junk foods, fast foods and convenience foods. You should avoid sugar from those foods as much as possible. Once you eliminate those from your diet,you significantly enhance your chances of being at a healthy weight and being healthy long term.

 

What About Protein Supplements And Similar Foods?

Of course, the dilemma is what you, as an intrepid label reader, should do about protein supplements, meal replacement bars, or snack bars. They are supposed to be healthy, but the label lists one or more sugars. Even worse, the sugar content is higher than your favorite health guru recommends.  So, should you avoid sugar from supplements and the like?

In this case, a more useful concept is glycemic index, which is a measure of the effect of the food on your blood sugar levels. Healthy foods like apples may have a high sugar content, but they havea low glycemic index.

avoid sugar and consume protein to slow absorbptionThe same is true for the protein supplements and bars you are considering. Rather than looking at the sugar content, you should be looking for the term “low glycemic” on the label. That means there is enough fiber and protein in the food to slow the absorption of sugar into the bloodstream and stabilize your blood sugar levels.

What Does This Mean For You?

Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should work on ways to avoid sugar or reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners. I have warned about the dangers of artificial sweeteners previously.

We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. For example, some Starbucks drinks are mostly sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

So we don’t have to avoid sugar completely, but we should reduce sugar from sugar sweetened beverages and junk food.

 

The Bottom Line

 

We need to keep warnings about the dangers of sugar in perspective:

  • The studies showing that sugar consumption leads to obesity, diabetes, and heart disease have all been done with sodas and junk foods.
  • Many fruits have just as much sugar as a soda. They also contain about the same proportion of fructose and glucose as high fructose corn syrup. Yet we know fruits are good for us.
  • Diets rich in fruits, vegetables and whole grains decrease our risk of obesity, diabetes, and heart disease.
  • That is because the sugar in whole foods is generally present along with fiber and protein, which slows the absorption of sugar and prevents the blood sugar spikes we get with sodas and junk foods.
  • In the case of prepared foods like protein supplements, you should look for “low glycemic” on the label rather than sugar content. Low glycemic means that there is enough fiber and protein in the product to slow the absorption of sugar and prevent blood sugar spikes.
  • Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should all work on ways to avoid sugar from junk foods or to reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners.
  • We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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