Recently, omega-3 fatty acids and fish oil supplements have attracted a lot of attention in the health community. There are claims that fish oil reduces the risks of inflammation, cardiovascular diseases, and cancer. As a result, many people view fish oil as the holy grail supplement to achieve impeccable health. However, some people are still skeptical.

Most people take fish oil supplements rather than getting it straight from whole foods. This raises a very important question that is rarely addressed. Do omega-3 fatty acids from fish oil supplements provide the same health benefits as omega-3 fatty acids that come directly from food?

Figure 1. A cell’s membrane is made primarily from phospholipids, cholesterol, carbohydrates, and proteins. This membrane allows the cell to interact with its environment in a controlled way.

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What Are Fatty Acids?

Fatty acids (FAs) are one of the fundamental building blocks of cells, tissues, and organs. They’re required for the synthesis of many biological molecules your body needs to function, including hormones. They make up the phospholipid bilayer of the cell membrane, keeping the cell intact and functioning. In addition, FAs are also a major supplier of energy when the body needs them. This is actually what the ketogenic diet is based on. As a result of low carbohydrate intake, your body will start oxidizing FAs for energy.

Polyunsaturated Fatty Acids

FAs come in various forms with many functions and while some can be synthesized by the body, many can only be obtained from our diet.

Polyunsaturated fatty acids (PUFAs) are essential FAs that are present in all membranes of our body. They consist of omega-6 PUFAs (n-6 PUFAs) and omega-3 PUFAs (n-3 PUFAs). N-3 PUFAs are essential nutrients that regulate brain function, hormone balance, immune system, and inflammation.

Types of n-3 PUFAs

• α-linolenic acid (ALA)
• Deicosapentaenoic acid (EPA)
• Docosahexaenoic acid (DHA)

Figure 2. Common sources of ALA, EPA and DHA. Notice how most of our foods are high in ALA. Copyright © 2021 Fit with Heba LLC, All rights reserved

High Levels of ALA Can Hurt You

In western diets, there is a severe deficiency in EPA and DHA intake. The 1:1 or 2:1 recommended ratio of ALA:EPA and DHA consumption has drastically increased to 20:1 or even higher today.^1,2

The body can convert dietary ALA into EPA and DHA. However, this conversion rate is very inefficient and never produces sufficient quantities. Therefore, EPA and DHA must be obtained through dietary sources regardless of how much ALA is consumed.

Figure 3. The skewed ratio of ALA: EPA and DHA. Copyright © 2021 Fit with Heba LLC, All rights reserved

One study found that 7% of ALA is converted to EPA and only 0.013% to DHA.³ Similarly, another study found that only 0.3% of ALA is converted to EPA and <0.01% to DHA.⁴ In other words, the conversion process remains utterly unreliable, particularly for DHA.

Evidence suggests that a diet high in ALA but low in EPA and DHA promotes the development of many diseases, including cardiovascular disease, dementia, and cancer. In contrast, increased levels of EPA and DHA exert suppressive effects and reduce the risk of sudden death.^5,6

Benefits of EPA and DHA on Chronic Illness

N-3 PUFAs can reduce inflammation and, as a result, may help lower the risk of chronic diseases such as heart disease, cancer, and arthritis. In addition, they regulate blood pressure, glucose tolerance, and nervous system development and functions.⁷ N-3 PUFAs consumption has been associated with improved cardiovascular function and reduce peripheral arterial disease and major coronary events.

EPA and DHA are essential for proper fetal development. For example, supplementation during pregnancy has also been linked to decreased immune responses and allergies in infants.

Benefits of EPA and DHA on Muscle

Research has observed a positive effect of n-3 PUFAs on muscle maintenance, anabolism, and catabolism not only in cancer cachexia but also in healthy volunteers.^8,9 Studies have shown a significant increase in muscle protein synthesis in both young and older subjects after eight weeks of supplementation with 4g/day of EPA and DHA.^10,11 Similarly, six months of supplementation with 3.36 g/day of EPA and DHA resulted in an increased muscle mass (+3.6%) and strength (+4%) in older people.⁷

Fish Oil Supplements Vs. Fresh Fish

Research has focused on the intake of EPA and DHA rather than the uptake. However, just because we consume a certain amount of nutrients does not mean our body is able to use it all. PUFAs digestion occurs effectively only after a high-fat meal, therefore small amounts of EPA and DHA are on average 13 times better absorbed with a high-fat than a low-fat meal.^12,13 Most people take fish oil supplements on their own and are not followed by a high-fat meal.

Studies have shown that fish oil supplementation does not provide the same benefits shown with the consumption of fresh fish.¹⁴

Figure 4. Omega-3 fatty acid dosage recommendations of the American Heart Association and the European Society for Clinical Investigation.¹⁵

Vegan EPA and DHA Sources and Sustainability

Relying on fish as a primary source of DHA and EPA is threatened by overfishing and the fact that the stocks of wild salmon, krill, and other species are contaminated with mercury or other pollutants. Krill is a life-sustaining food for numerous marine animals therefore krill conservation is necessary and cannot be relied on for EPA and DHA.

Microalgae are a sustainable source of DHA and EPA and evidence suggests that the bioavailability and delivery of EPA and DHA in algae are the same in fish.^16,17 However, the cost, extraction, and purification methods of EPA and DHA from microalgae are currently limited. As a result, additional experimentation is required to ensure optimal growth conditions for enhancing n-3 PUFAs content, ideal species selection, and quality control.

Credits

The cover photo of this blog is by Vanessa Loring from Pexels

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References

1. Simopoulos AP. An increase in the Omega-6/Omega-3 fatty acid ratio increases the risk for obesity. Nutrients. 2016.
2. Simopoulos AP. Evolutionary aspects of diet: The omega-6/omega-3 ratio and the brain. Mol Neurobiol. 2011.
3. Goyens PLL, Spilker ME, Zock PL, Katan MB, Mensink RP. Compartmental modeling to quantify α-linolenic acid conversion after longer term intake of multiple tracer boluses. J Lipid Res. 2005.
4. Hussein N, Ah-Sing E, Wilkinson P, Leach C, Griffin BA, Millward DJ. Long-chain conversion of [13C]linoleic acid and α-linolenic acid in response to marked changes in their dietary intake in men. J Lipid Res. 2005.
5. Patterson E, Wall R, Fitzgerald GF, Ross RP, Stanton C. Health Implications of High Dietary Omega-6 Polyunsaturated Fatty Acids. Journal of Nutrition and Metabolism. 2012.
6. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. Am J Clin Nutr. 2000.
7. Wall R, Ross RP, Fitzgerald GF, Stanton C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 2010.
8. Smith GI, Julliand S, Reeds DN, Sinacore DR, Klein S, Mittendorfer B. Fish oil-derived n-3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015.
9. Wigmore SJ, Barber MD, Ross JA, Tisdale MJ, Fearon KC. Effect of oral eicosapentaenoic acid on weight loss in patients with pancreatic cancer. Nutr Cancer. 2000.
10. Gingras AA, White PJ, Chouinard PY, Julien P, Davis TA, Dombrowski L, Couture Y, Dubreuil P, Myre A, Bergeron K, Marette A, Thivierge MC. Long-chain omega-3 fatty acids regulate bovine whole-body protein metabolism by promoting muscle insulin signalling to the Akt-mTOR-S6K1 pathway and insulin sensitivity. J Physiol. 2007.
11. Smith GI, Atherton P, Reeds DN, Mohammed BS, Rankin D, Rennie MJ, Mittendorfer B. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci (Lond). 2011.
12. Cook CM, Hallaråker H, Sæbø PC, Innis SM, Kelley KM, Sanoshy KD, Berger A, Maki KC. Bioavailability of long chain omega-3 polyunsaturated fatty acids from phospholipid-rich herring roe oil in men and women with mildly elevated triacylglycerols. Prostaglandins Leukot Essent Fatty Acids. 2016.
13. Davidson MH, Johnson J, Rooney MW, Kyle ML, Kling DF. A novel omega-3 free fatty acid formulation has dramatically improved bioavailability during a low-fat diet compared with omega-3-acid ethyl esters: the ECLIPSE (Epanova(®) compared to Lovaza(®) in a pharmacokinetic single-dose evaluation) study. J Clin Lipidol. 2012.
14. Zibaeenezhad MJ, Ghavipisheh M, Attar A, Aslani A. Comparison of the effect of omega-3 supplements and fresh fish on lipid profile: A randomized, open-labeled trial. Nutr Diabetes. 2017.
15. Schwalfenberg G. Omega-3 fatty acids: their beneficial role in cardiovascular health [published correction appears in Can Fam Physician. Can Fam Physician. 2006.
16. Lane K, Derbyshire E, Li W, Brennan C. Bioavailability and Potential Uses of Vegetarian Sources of Omega-3 Fatty Acids: A Review of the Literature. Crit Rev Food Sci Nutr. 2014.
17. Arterburn LM, Oken HA, Bailey Hall E, Hamersley J, Kuratko CN, Hoffman JP. Algal-Oil Capsules and Cooked Salmon: Nutritionally Equivalent Sources of Docosahexaenoic Acid. J Am Diet Assoc. 2008.