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What does the evidence say about the importance and efficacy of omega-3s

There is a lot of information on Omega 3's these days. This is a long article with vital information for your health. The bottom line is this. Your body needs omega 3 essential fatty acids. You've heard competing claims that red wine is good for the heart — and alcohol causes cancer. Research has shown butter clogs arteries, but then the media tells us “butter is back.” So is fish oil effective against heart disease, or is it not? Thanks to Ocean Robbins for this great and in-depth article.

The best source is from fish oil. Quality matters. Most brands don’t give you enough of the therapeutic ingredients EPA & DHA to make a difference. They also use fish contaminated with dangerous heavy medals like mercury. Or they finish the product with hexane, a petroleum product. Depending on your genetics that can be very damaging. The kind I take is Pro Omega 2000 from Nordic Naturals. If you’ve already created a Fullscript account you can order it there or follow this link and create one. Of course, fish oil and omega-3s, while synonymous in the broad wash of sloppy media coverage, are not the same thing. What, then, does the evidence say about the importance and efficacy of omega-3s? How much do you need to function at your best? And if you don’t eat fish or take fish oil supplements, can you reliably get enough from vegan sources? Heck, what are the best sources of these nutrients anyway? What Are Omega-3s? Omega-3s are a type of polyunsaturated fatty acid (a family of compounds signified by the acronym PUFA, which sounds like a Teletubby or an extremely comfortable chair). They fall into the category of essential fatty acids. In nutrition, “essential” simply means you can’t make them yourself, so you have to source them externally, either through food or supplementation. In chemical nomenclature, the “omega” signifies the location of the double bond in its carbon chain. It has nothing to do with the Omega watches that James Bond wears, although his last name does make me wonder. There are 3 types of omega-3s: ALA, EPA, and DHA. ALA (alpha-linolenic acid) fats are mostly metabolized in your intestines and liver and are needed for energy. ALA is a shorter long-chain fatty acid precursor, meaning your body can also convert ALA into the other two long-chain omega-3s, EPA and DHA. However, research indicates that most of us are not very efficient at converting ALA to EPA and DHA. An average of just 1–10% of ALA is converted into EPA, and 0.5–5% into DHA. The conversion rate can vary significantly between people, depending on factors like genetics, age, and health status. Interestingly, women may be better at this conversion than men, thanks to higher estrogen levels.

  1. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are long-chain omega-3 fatty acids whose names sound nothing like Teletubbies. Both can be converted from ALA as mentioned above, but you can also get EPA and DHA from food and supplements. These two omega-3s offer more potent health benefits than ALA. For instance, EPA helps manage inflammation in the body, and DHA is crucial for maintaining brain health.

How Much of the Omega-3s Do You Need? The recommended daily intake of omega-3s by age group is as follows : 0-6 months: .5 g 7-12 months: .5 g 1-3 years: .7 g 4-8 years: .9 g 9-13 years: 1.2 g (male), 1 g (female) 14+ years: 1.6 g (male), 1.1 g (female) Pregnancy: 1.4 g Breastfeeding: 1.3 g But aside from babies up to one year old, these omega-3 numbers are only based on ALA intake. Even though there are no official guidelines for DHA and EPA, research suggests that combined EPA and DHA intake should be between 250-500 mg per day, for adults. Meanwhile, surveys have shown that most American adults are only getting around 90 mg per day of EPA and DHA combined, which means that most of us are getting between ⅓ and ⅙ the amount we need for optimal health. A 2019 study published in the journal Nutrients assessed the omega-3 intake of over 45,000 Americans, finding that every age group fell short when it came to meeting daily recommended intakes. If we were doing as badly on protein, vitamin C, or calories, it would be considered a public health emergency. Once you see how important omega-3s are to your health, you might see it that way yourself. Omega-3 Health Benefits. Most of the research on the potential health benefits of omega-3s has focused on fish and fish oil. Observational studies have linked higher intakes of fish and seafood to better outcomes related to heart and brain health, inflammation, cancer, and even IQ scores. In a 2019 review of 44 studies that was published in the highly specialized medical journal PLEFA (“Prostaglandins, Leukotrienes & Essential Fatty Acids” isn’t what most people would call light reading), researchers concluded that children who ate seafood had better school grades, and higher IQs by as much as 9.5 points when compared to their peers who ate no fish. Whoa, that sounds like a huge difference! But the problem is, we don’t know exactly why fish appears to be helpful. Is it because most types of fish are high in omega-3s (which they are), and omega-3s are awesome for us? Or is it because fish is less harmful than the food it replaces, like red meat and heavily processed foods? The jury is still out on whether the healthiest diet contains some fish, or is completely animal-free. To reach clarity on this topic, we would need clinical trials conducted over long periods of time, with highly compliant participants willing to stick to a particular eating pattern for decades. In other words, we may never know with certainty. Still, we do have some research that points to the considerable health benefits of omega-3s — whether or not they are derived from fish. Here are six areas in which omega-3s appear crucial. 1. May reduce your risk for heart disease. Even with all the controversies, there is solid evidence that getting enough omega-3s can protect your heart. In fact, they have been shown to significantly lower your risk for sudden death from heart arrhythmias and all-cause mortality among people with known coronary heart disease. Omega-3s have also been shown to be effective in lowering LDL cholesterol and triglycerides, as well as high blood pressure, which are all risk factors for heart disease. Omega-3s can also raise HDL (“good”) cholesterol, reduce platelet aggregation, prevent coronary artery blockages, reduce the chance of abnormal heart rhythm, lower inflammation, and improve arterial health by helping prevent the buildup of plaque. 2. Support brain health and development. Getting enough omega-3s is particularly essential early in life, as the brain grows and develops. But that doesn’t mean it’s not important later, too. In fact, a 2018 review discussed how omega-3 fats may benefit mild cognitive impairment, such as in the instance of major depressive disorder or Alzheimer’s dementia. Omega-3s have a potent anti-inflammatory and antioxidant effect in the brain. So while extra omega-3s may not turn you or your child into an Einstein, not enough can impair brain development in infancy and childhood, and is associated with higher rates of dementia and depression in adulthood. 3. May have immune benefits. Omega-3 fats are considered immunonutrients, meaning they have a unique role in the cell signaling and cellular structure of the immune system. As such, they’re commonly used as part of treatment protocols for cancer patients. Omega-3 fats are known to suppress inflammatory processes throughout the body. This has notable benefits for reducing cardiovascular disease, rheumatoid arthritis, dementia, and many other serious conditions. But you may wonder whether the anti-inflammatory effect of omega-3s could reduce the effectiveness of the immune system since inflammation is one of its key mechanisms. It turns out otherwise, though. Omega-3s appear to ramp up the actions of the beta immune cells, leading to healthier and more calibrated immune responses. 4. May support eye health. Having enough omega-3s circulating in your body may help prevent age-related macular degeneration (AMD), a common eye condition that can result in vision loss. One 2014 study found that higher levels of EPA, DHA, and markers of long-chain polyunsaturated fatty acid storage were strongly associated with a reduced risk for AMD. 5. May help boost your mood. With the increased prevalence of mental health concerns like depression, the use of supplements like omega-3 have also increased. And it seems like this may be worthwhile for many people. A 2019 meta-analysis found that omega-3 supplements with an EPA concentration of at least 60%, and taken at a dosage of ≤1 gram per day, have beneficial effects on depression. Other studies on omega-3 supplementation have led to mixed results. But it’s generally thought that EPA may benefit people with depression, while DHA may reduce the risk of suicide. 6. Offer anti-inflammatory benefits. Many studies, using a placebo control, have found that omega-3 supplements are as effective as anti-inflammatory medications in terms of reducing symptoms of chronic inflammatory diseases. But instead of negative side effects, they might also provide benefits to your heart, brain, immune system, eyes, and mood! Omega-3 Deficiency. With all these amazing benefits of omega-3s, there’s no question they’re important for your health. And not getting enough can have serious consequences if it’s not identified and properly addressed. Omega-3 fatty acid deficiency may lead to dry scaly rash, decreased growth in infants and children, increased susceptibility to infection, and poor wound healing. Given the activity of omega-3s in your brain, not getting enough of them can also lead to brain impairment, including effects on your memory and ability to think clearly. Fortunately, true deficiency of omega-3s is very rare, at least in the US. It’s more common to experience omega-3 insufficiency, where you’re getting some, but not enough for optimal benefits. As mentioned earlier, in the US, the average intake of EPA and DHA from food sources is about 90 mg in adults. This equates to about ⅓-⅙ of recommended amounts, leaving many of us with EPA and DHA insufficiency. Of course some people are able to convert ALA to EPA and DHA but not always with great efficiency. Getting enough ALA is a concern too, although it’s less of a problem because it’s found in more foods, particularly on a plant-based diet. In adults aged 20 years and older, the average daily ALA intake from foods is estimated to fall around 1.59 grams in females and 2.06 grams in males. Omega-6 to Omega-3 Ratio. Getting enough omega-3s isn’t the only factor to consider, however. It’s also important to understand how much you’re getting in relation to other omega fatty acids — namely omega-6s. You can find omega-6s in most vegetable oils, with sunflower, corn, soybean, safflower and cottonseed oils containing the highest amounts. Olive oil and avocado oil are an exception, as they are not high in omega-6s. But the standard western diet is notorious for giving us way too many omega-6s compared to omega-3s. This is a serious problem because too much omega-6 in your diet can have a pro-inflammatory effect in the body and increase your risk of various chronic diseases. In general, omega-6s are pro-inflammatory, while omega-3s are anti-inflammatory. But it’s not that one is bad and one is good — you need both, just in the right proportion. So what’s the optimal ratio of the two? Ideally, you want an omega-6 to omega-3 ratio somewhere between 4:1 to 1:1. Some sources estimate that the ratio of the average American falls around 16:1. Yikes! If your diet is heavy on the omega-6 side, this can actually reduce how efficiently your body can convert ALA to EPA and DHA which, as we mentioned earlier, is already a fairly low conversion rate for most people. This appears to be because some omega-6s compete for the same enzymes in order to complete these conversions. Reducing your dietary omega-6s can also increase the bioavailability of omega-3s. Who’s Most at Risk of Deficiency? There are certain groups of people at higher risk of omega-3 deficiency. One example is people dependent on feeding tubes, in which nutrition is delivered directly to the stomach, bypassing the mouth and esophagus. Their risk is magnified if they have malabsorption issues and are dependent on feeding tubes long-term. Other populations may have insufficient levels of omega-3, and of EPA and DHA, in particular. Vegans and vegetarians who do not eat seafood may be at risk of deficiency, as fish is high in EPA and DHA. If this is you, don’t despair; we’ll talk about alternative sources below. Adults over 65 years of age can be at a higher risk for nutritional deficiencies in general, due to reduced appetite and less efficient nutrient absorption and metabolism. This may mean a higher risk for fatty acid deficiencies, though more studies are needed to assess omega-3 status in specific age groups. Lastly, people who eat a westernized diet have a higher risk for omega-3 insufficiency even if they do include some seafood in their diets. This is because the western diet includes so many pro-inflammatory foods, such as ultra-processed and highly refined grains, oils, and added sugar. One 2016 study that looked at the EPA and DHA blood levels among various populations found that fatty acid levels are higher in places where people are eating a more traditional diet and haven’t fully adopted a western dietary pattern. Omega-3 Fatty Acid Testing Unlike tests for cholesterol or fasting blood sugar, tests for fatty acid deficiency are not routine diagnostics. Doctors tend to prescribe this test just for pregnant women or people with cardiovascular disease. However, you can request a fatty acid test from your doctor if you’re curious or concerned. The fatty acid test is a fasting blood test, which means you can’t eat or drink anything (except water) the night before (so it’s best to schedule for the morning). The results will tell you your omega-3 (EPA+DHA) index, which generally falls between 1.4-4.9%. Ideally, your results will be greater than 3.2%. Additionally, it can tell you your omega-6 to omega-3 ratio. If you want to get testing done without requiring a doctor’s prescription, find out how to use Ulta Lab to get your omega-3 levels checked, here (USA only). Sources of Omega-3 You can get omega-3 fats from whole foods, fortified foods, and supplements. Depending on your needs and dietary preferences, you can mix and match from these sources to achieve healthy levels of these nutrients. Food Sources ALA Some of the best vegan sources of ALA include flaxseeds, chia seeds, hemp seeds, and walnuts. Try love adding these to smoothies, sprinkling them onto salads, adding them to oatmeal, or mixing them into batters for homemade muffins, waffles, and breads. Certain types of beans also contain small amounts of ALA, such as edamame and kidney beans. While it’s easy to get enough ALA through nuts and seeds, this approach may not meet your needs for the other two essential omega-3s, since as we’ve seen, we humans are not great at converting ALA into DHA and EPA. DHA and EPA The best sources of DHA and EPA come from the ocean. Fish is a plentiful source, but also can contain high levels of mercury and heavy metals. And large-scale fishing comes with serious ethical and sustainability concerns, as the 2021 Netflix documentary Seaspiracy makes abundantly clear. Cold-water, fatty fish like tuna, halibut, salmon, sardines, and mackerel typically deliver the most DHA and EPA, but this also depends on the composition of the food that the fish consumes. After all, macronutrients move up the food chain from their origin — photosynthesizing plants! And while we tend to think of plants as landlubbers, of course, the ocean is full of them as well. Sea vegetables, like seaweed and algae, also contain EPA and DHA. In fact, just two tablespoons of dried wakame seaweed offers 18.8 mg of omega-3 fatty acids. These types of sea vegetables can be enjoyed in a variety of ways. You can use nori sheets to make plant-based sushi rolls, and add flakes or ribbons of kelp, dulse, and wakame to salads and veggie dishes for a unique flavor and texture. You can also enjoy leafy sea vegetables in miso soup. Increasingly, manufacturers are fortifying foods with DHA and EPA as well. Some brands of eggs, yogurt, juices, milk, and even plant-based pea and soy beverages, are fortified with DHA oil. Unfortunately, it’s hard to assess the quality of this oil, especially compared to the most respected brands of omega-3 supplements. Omega-3 Supplements The omega-3 trio can also be found — sometimes more consistently and reliably, depending on your diet pattern — in supplemental form. ALA The most concentrated, supplemental, non-whole food source of ALA is flax oil. This provides a higher dose of ALA than you can obtain from flaxseeds themselves, or from other ALA-containing foods. You can find flax oil in the cooking and baking oil aisle at many stores, or in some cases, the refrigerated supplement section. Buyer beware, however: flax oil degrades quickly, so the fresher the better. You want to look for an expiration date that is as far into the future as possible. And again, you may not be able to rely on ALA to provide all your omega-3 needs; we’re just not good enough at converting it into DHA and EPA to consistently make the math work. EPA and DHA Supplemental EPA and DHA are often sourced from fish oil, krill oil, and cod liver oil. These may come in actual liquid form or in capsules. When derived from seafood, they come with many of the same health, environmental, and ethical concerns. In addition, while there’s evidence that eating fish can reduce cardiovascular risk, research has not shown a similar benefit from supplemental fish oil. While high doses can reduce triglycerides, that doesn’t seem to translate into less heart disease. The good news is, omega-3s can also be found in algal oil, which is a vegan-friendly alternative to fish oil. It’s also more sustainable than fishing, as algae grows quickly and doesn’t contribute to overfishing. Algae can be grown under controlled conditions, free from toxins like mercury and microplastics, that may be present in fish and fish oils. Most importantly, algal oil appears to be at least as effective as fish oil because, again, fish get their omega-3s from eating algae and other ocean plant life anyway. Choosing algal oils basically lets you cut out the middlefish. Compared to fish oils, however, vegan omega-3s from algae oils have been found to be higher in DHA and lower in EPA. Since both EPA and DHA confer unique and important benefits, you may want to consider making sure that any algal omega-3 supplements contain a balance of both. Omega-3 from Algae Supplements Is an algae-based omega-3 supplement the right choice for you? People who may want to add a supplement to their routine include those most at risk of deficiency, like pregnant women, people over 65, and those who don’t regularly consume fatty fish. Fortunately, there are a variety of vegan, algae-based DHA and EPA supplements on the market. Risks & Side Effects of Taking Omega-3 Supplements While omega-3s in supplemental form are convenient and more reliable than dietary sources for most people, they do come with some potential side effects to consider. Based on current study dosages, it appears that adults may safely consume up to 3,000 mg of fish oil daily. No upper limit has been established for algal oil, but likely a similar amount is safe. Side effects of taking omega-3s, primarily as fish oil, can include an unpleasant taste of the supplement itself that lingers in your mouth, bad breath, heartburn, nausea, gastrointestinal discomfort, diarrhea, headache, and even odoriferous sweat with more than a hint of “off-season fish market.” If you’d like to avoid fishy armpits, for example, algal oil may be a better option as users generally don’t report those particular side effects. Additionally, any type of omega-3 supplement may interact with Warfarin and other anticoagulant medications, so it’s best to avoid adding omega-3s to your routine if you take one of these, at least until you speak with your healthcare provider. Fish oil may also increase the risk of atrial fibrillation (Afib), or irregular heartbeat, in people with existing heart disease or who are at a higher risk of developing heart disease. One 2021 study by the European Society of Cardiology found that taking fish oil supplements was associated with a higher likelihood of developing Afib among people with high triglyceride levels. We don’t know if the same is true of algal oil, but it certainly could be. Again, it’s always a good idea to speak to a health professional before adding a new supplement to your lifestyle to make sure it’s appropriate for you. The plant Purslane is vegan source of omega 3s. Of course you would need too eat a room full of it for a therapeutic dose. It's a bit sour and succulent if you like that taste. Makes a great addition to a salad . Purslane is a weed. Maybe you can grow it in your garden. Purslane plants are all too easy to grow. You can find them growing wild in your flower and vegetable gardens, as well as in cracks in your sidewalk or driveway. Purslane grows in just about any soil, from a rich, fertile soil, to dry, rocky soils. It is drought tolerant.

As always… Here’s to your best health! Dr. Linda P.S You can search on Fullscript for Pro Omega 2000 from Nordic Naturals. Click here to create or open your Fullscript account and get a 10% discount and free shipping on orders of $50 or more.

Fun Fact: An omega-3 fatty acid is highly recommended for people who want to lose weight but excess consumption might show an opposite result. As you already know fish oil is rich in fat and is also high in calories, therefore, too much of it can increase your metabolic weight.

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