If you do not consume fish it may be recommended that you consider taking a fish oil supplement.
Here are a few things to know prior to buying a fish oil supplement:
Don’t get fooled by the labeling. Often I talk with patients who are taking doses of fish oil that are far lower than what research shows to be effective for their specific indication. On the front of the bottle it may say “1000mg” and “omega-3’s” but make sure to read the supplement facts label on the back. Notice the serving size and the amount of EPA + DHA, this is what matters and is how fish oil should be dosed. If you are told to take 1000mg of Omega-3’s what the practitioner is likely referring to is the amount of EPA + DHA (it’s important to clarify this with your provider).
Fish oil is best taken with a meal that contains fat and in divided doses (ie. with breakfast or lunch and supper).
There are a few different formulations of fish oil. These include natural triglycerides, free fatty acids, phospholipids and most common ethyl ester and re-esterified triglyceride forms. The re-esterified triglyceride form is ~75% better absorbed than the ethyl ester form when taken without food but when taken with fat absorption appears to be similar among the formulations. (1)
In nature about 1/3 of the oil derived from fish is EPA + DHA, so when you look at a supplement label if there are 1000mg of fish oil and about 300mg are EPA+DHA it is not a concentrated formulation and may require taking more capsules.
When it comes to fish oil supplements QUALITY MATTERS! A 2017 Norwegian study found that “non-oxidized” fish oil lowered LDL (“bad”) cholesterol 6% while “oxidized” (a.k.a. rancid) fish oil actually raised LDL 19%! That’s right, if your fish oil isn’t “fresh” it can actually make your cholesterol worse! (2)
I often talk with patients who tell me they don’t take fish oil because it tastes or smells terrible. This is the first red flag. If you are taking a brand of fish oil that tastes and/or smells terrible (beyond the expected subtle fishy smell/taste…because obviously it is fish oil) consider switching to a higher quality product. Fish oil is not a supplement that I would recommend buying whatever is cheapest.
Keep your fish oil fresh by storing it in the refrigerator or freezer, away from heat, moisture and light.
I generally advise using capsules over liquid formulations of fish oil as these tend to go rancid more quickly once exposed to air. If you prefer a liquid formulation, avoid flavored ones (flavors can cover up off taste and potential rancidity) and use the oil within two weeks of opening it.
A Canadian study found that >50% of supplements tested exceeded voluntary limits placed on fish oil oxidation. (3) With this in mind do your research before purchasing fish oil and if your sences tells your something is “off” about your fish oil supplement…it likely is!