Essential Fatty Acid Supplements

Summary: Eating adequate amounts of undamaged oils is essential for health. A good plan is to eat a few raw walnuts and almonds or sunflower seeds daily, and try to eat omega 3-rich fish like salmon, mackerel, tuna, and/or sardines once per week. EPA and DHA supplements (like salmon oil) or omega 3 flax oil supplements can be helpful. Do not use omega 6 GLA supplements long term without balancing them with at least 10 times more EPA/DHA (e.g. 50mg GLA to 500mg EPA/DHA per day).Some of the best EFA supplements for the money are Enzymatic Therapy Eskimo-3, Natural Factors RX Omega-3 Factors, Jarrow Formulas Omega Balance, and Carlson's Fish Oil.

Omega 6 oils are common in the diet and are not usually necessary to supplement. Raw almonds or sunflower seeds are a good source of undamaged omega 6 oils and a few can be eaten daily to ensure their supply. Using GLA, a body-ready source of omega 6 oil, can be helpful for some conditions, but should be used with caution. See below.

Omega 3 oils are harder to get in the diet. EPA (fish, usually salmon, oil) is a good supplement to take to get adequate omega 3's, especially if sufficient fish is not eaten. Sometimes it is crucial if diet is poor. One of the better EPA supplements is Enzymatic Therapy Eskimo-3, also sold as Prevail Eskimo-3 . It is in small capsules, and the least fishy-tasting if they are chewed. Plant source DHA can substitute for EPA/DHA fish oil if desired.Carlson's Fish Oil is a liquid and provides a large amount of EPA per teaspoon. It is lemon flavored and does not taste bad at all. It can be used as a base for salad dressing, too. It also comes in (large) liquigels.

A new and excellent product is Coromega Omega-3 fish oil supplements. They are packets (90 to a box) of a high potency omega 3 oil and are either orange or chocolate-orange flavored, sweetened with stevia, and suitable for kids or adults who do not like to take capsules or find the taste of other liquid fish oils objectionable.

Flax oil is a good source of omega 3 oils, but in a form which must be converted by the body to be used. If there is a problem with the conversion (see Essential Fatty Acid Metabolism) an EPA/DHA supplement is much more beneficial. Flax oil can go rancid quickly with exposure to high temperature, light, or oxygen in which case it can be harmful to health. Use only cold-processed ones which exclude light and air, as are those produced with the omega-flo process. Excess flax oil can also cause problems with EFA metabolism. Taking one or two tablespoons per day is a healthy habit and can serve as an excellent source of omega 3's. Taking four or even three tablespoons per day may be too much for some, and could inhibit the body's use of all EFAs, omega 3's and 6's. For most people, using EPA fish oil is more effective. However, if plenty of protein is provided with the type of omega 3 in flax oil, this improves the conversion rate a good deal. A highly recommended food to fight some illnesses is flax oil mixed with cottage cheese. When large amounts of raw omega 3 are efficiently converted into EPA, it is like using a lot of fish oil capsules and can be very beneficial.

DHA is similar to EPA and need not be converted by the body before use like flax oil. Most EPA fish oil supplements also contains DHA. However, unlike EPA, DHA can come from a vegetarian source - algae - so is preferred by some. It is usually far less potent than EPA, but since it does not come from fish oil, is less likely to cause fishy burps which can occur with some people using EPA fish oil supplements. Source Naturals makes one of the most popular DHA supplements called Neuromins DHA. The most popular use of DHA supplements is in pregnancy since many pregnant women could not use EPA supplements in the past due to the fishy burp issue causing nausea, although now that all good EPA fish oil supplements are molecularly distilled, this is not as much an issue as it was in the past.

EPA and EFA are two abbreviations often used when discussing fatty acid supplements. EFA stands for Essential Fatty Acid, and means a type of oil that is required to consume since the body cannot create it from other oils. An EFA can be either an omega 6 or omega 3 oil. EPA is a type of oil found in a some types of fish and very few other sources and stands for eicosapentaenoic acid. DHA stands for docosohexanoic acid and is another type of omega 3 oil which can be found in plants as well as EPA sources like fish. DHA is generally as beneficial as EPA since no enzymes are required to convert it into a body useable form.

GLA supplements are popular, especially for inflammatory disorders. GLA is found primarily in evening primrose, borage, and black currant oils. Many times it does provide great relief by stimulating antiinflammatory hormones to be produced in the body and does appear to help regeneration. But, excess GLA used long term can actually increase inflammatory problems if it is not balanced with sufficient EPA (or plain omega 3 oil if the conversion process in the body is working well). Sometimes this can take a month, sometimes six. Numerous times I have talked with people who took a GLA supplement for arthritis pain or other malady whose problem suddenly took a turn for the worse. Stopping the GLA, or switching the GLA for EPA, would typically provide relief in a few days. This would invariably be something they had no idea was causing the problem since it provided such relief when they first started using it. Barry Sears and others who know fatty acid metabolism say that it should be supplemented in a 1:20 or greater ratio with EPA/DHA, in other words, 50mg GLA to 1000mg EPA. See Essential Fatty Acid Metabolism in the diet section. One of the only widely available EPA/GLA supplements (which also includes some stearadonic and CLA) that has the best ratio is Jarrow Formulas Omega Balance, but it is still 1:10. It is far better than any other widely available EPA/GLA supplements, though, which are usually around 1:1 to 1:2.

However, the Omega Balance does not really contain that much EPA per serving, and this is the omega 3 oil that does the most good and is hardest to get in the diet. If sufficient omega 6 oils are consumed, a plain EPA fish oil supplement is better. The Enzymatic Eskimo-3 is higher in EPA, which is also a very good value when comparing amounts of EPA and DHA for the money. Most good quality EPA omega 3 supplements are fine to use. They should be molecularly distilled to exclude heavy metals (especially mercury) or otherwise assayed for it. It used to be difficult to find this type, but now all reputable brands meet this criteria, with only some cheap department and drug store types failing this test.

Diet is an important aspect of how EFAs are used in the body. Eat too many carbs and not enough protein and the body tends to produce more inflammatory and blood clotting hormones with the omega 6 oils it gets. If adequate protein is eaten, the fats are used more efficiently, energy levels are boosted, weight regulation hormones are stimulated, and more antiinflammatory hormones are produced. For technical information and a diagram of the process, again, see Essential Fatty Acid Metabolism in the diet section.

Cod liver oil is rich in omega 3 fatty acids, and also contains a lot of vitamins A and D. It is especially good to use during the winter in colder climates to provide extra vitamin D that is not being provided by the sun. This is the potentially harmful form of vitamin A, though, and should not be used during pregancy or too much long term. However, short term or seasonal use of cod liver oil can be helpful for some disorders, particularly depression, and also possibly infectious maladies as well.

It is not necessary to use an essential fatty acid supplement if one avoids damaged oils and the diet is adequate with EFAs, although it does help in cases of poor diet and especially when there is a lack of nutrients that prevents the proper enzymatic reactions from converting the oils into usable forms, or for special purposes such as heart and circulation disorders. See the diet section article Fats and Oils for more information.

From Dr. Murray's Natural Living

Conspiracy, bias, or just plain stupidity? Part II.


In a previous newsletter, I broached the subject that there appears to be something “fishy” about the portrayal of natural products in the major medical journals. I questioned whether the major medical journals are truly presenting accurate information and pointed out that even the editors or former editors of prestigious journals like the Lancet, New England Journal of Medicine, and British Medical are simply extensions of the marketing departments of major drug companies.

Previously, a review published in the Journal of the American Medical Association estimated that 95% of medical studies in the most prestigious journals contain false or misleading statistics. To illustrate the nature of the problem, let’s take a look at the most recent “negative” review of fish oils against cardiovascular mortality.

In case you missed it, in early April 2006 the media headlines claimed “Fish oil Supplements have no Effect on Heart Disease or Cancer.” The source of these false statements was a review article published in BMJ (British Medical Journal).1 What the study concluded and what the media grabbed a hold of was that the “Long chain and shorter chain omega 3 fats do not have a clear effect on total mortality, combined cardiovascular events, or cancer.” That is far different than saying that they do not have benefit. So, what is the truth behind the headline? Read on. But, before you do I want to stress here first is that the use of a high quality fish oil supplement is one of the most important tools in the prevention and treatment of many diseases. That fact is irrefutable based upon a large body of clinical evidence from double-blind, placebo-controlled trials.

What did the Study Really Say?

According to the lead author of the study, Dr. Lee Hooper:

“We did not report that ‘long chain omega-3 does not offer any protection from heart disease’, that ‘omega-3 fats have no effect on total mortality, combined cardiovascular events, or cancer’ or that omega 3 fats are of ‘no benefit’ - this is not what we found, or what we reported (despite our being misquoted in much of the press).”2

That is very interesting. So, what Dr. Hooper and his group actually found by looking at the data was that omega-3 fatty acid intake was associated with a 13% reduction on mortality. I think that finding is quite in line with what one might expect. While long-chain omega-3 fatty acids from fish oils clearly reduce the risk for heart attacks and strokes (previous reports show somewhere between 25-40%),3-5 it is highly unlikely that they would impact other causes of mortality. Therefore, when selecting total mortality as the study’s endpoint we need to make some adjustments. For example, given that heart attacks and strokes would account for between one-quarter to one-half of all deaths in the populations studied it would be expected that long-chain omega-3 fatty acid intake would reduce total mortality somewhere between 6% (25% reduction x 25% heart attack and stroke deaths) to 20% (40% reduction x 50% CHD deaths), or an average of 13% overall. Hey, wait a minute. That 13% reduction is exactly the same number that Dr. Hooper found in his analysis of the results from the randomized trials using fish oil supplements. Interesting, isn’t it?

Some Issues with the Study

First of all, the study was not a new study at all. What it was is a detailed review and meta-analysis. The authors of a meta-analysis review the medical literature and then select published studies to include in their analysis based upon the studies meeting certain criteria. A meta-analysis is almost always fraught with methodological issues and this study was no different.

One of the first issues to mention is that the biggest problem with meta-analysis type reviews is that they are often the collection of poorly designed studies. If all the studies are of high quality and well-designed, a meta-analysis can be quite helpful to illustrate statistical significance because the total number of subjects is often greatly increased. However, if the meta-analysis includes a very large poorly designed study it can tip the scales to a very wrong conclusion. That appears to be exactly what happened in this particular meta-analysis. In fact, the overall conclusion of the meta-analysis can be changed from “no benefit” to “clear benefit” simply by eliminating one flawed study (DART-2). This study should not have been included in the first place because of its poor methodological quality. I am not making that judgment. TheU.S. Department of Health and Human Services’ Evidence Report from 2005 states that this study is of very poor methodology.7 One of the biggest problems with the study was that the dietary instructions were only given at the start of the 9-year study and again after 6 months. Lack of compliance was obviously a huge problem. The study failed to demonstrate compliance in 98% of the subjects. Again, if this study is excluded (as it should have been) the results are also changed from “no benefit” to “clear benefit.” Clearly, the results of the well-designed studies show considerable benefits from a higher intake of the long-chain omega-3 fatty acids from fish oils.

Another huge problem with the meta-analysis is that many of the studies utilized based the intake of omega-3 fatty acids upon dietary questionnaires. These sorts of food frequency questionnaires used have been sharply criticized because they are often so inaccurate. So, what should researchers use instead? Well, in evaluating the role of omega-3 fatty acids they should rely on blood measurements. For example, in one study published in the New England Journal of Medicine that measured the levels of the long-chain omega-3 fatty acids EPA and DHA in the blood it was demonstrated that these omega-3 fatty acids produced a very clear reduction in heart attacks.8 The group with the highest intake of EPA and DHA had an 80% reduced risk of a fatal heart attack compared to the group with the lowest intake.

Next, I have a big issue when the effects of fish consumption are linked to the effects of the long-chain omega-3 fatty acids. Sure, fish is the best natural source of the long-chain omega-3 fatty acids, but our fish supply is also tainted with mercury, lead, pesticide residues, and other harmful compounds. Mercury has been known to increase the risk of cardiovascular disease. While fish oils may protect against heart disease, is the benefit of eating fish counteracted by a higher intake of mercury? Apparently not as results from another study published in the New England Journal of Medicine show that while higher body levels EPA and DHA were associated with a decreased risk for heart attacks, the higher the body mercury level the greater risk of a heart attack.9 Researchers concluded that the high mercury content of fish may diminish the protective effect of fish intake against heart disease. So, it is entirely inappropriate to lump fish consumption into the analysis of the health benefits of the long-chain omega-3 fatty acids.

Another mistake is pooling the data with both the long-chain omega-3 fatty acids from fish oils with the short-chain omega-3 fatty acids alpha- linolenic acid. While the data on the beneficial effects of the long-chain omega-3 fatty acids is quite solid, for alpha- linolenic acid the evidence is less convincing and randomized controlled trials are lacking. One of the studies included in the analysis that should not have been was conducted not on fish oil, but rather a margarine containing alpha-linolenic acid (ALA) - that's the omega 3 found in flax - versus a margarine with linoleic acid (an omega-6 fatty acid).10 Again, including this study appears inappropriate and its exclusion may have changed the picture entirely.

Lastly, it has been stated that “conducting a meta-analysis study on the effectiveness of omega-3 fats for mortality, cardiovascular disease and cancer, without considering the impact of excess omega-6 fat in the diet, is akin to reviewing the efficacy of a healthy diet without factoring the effects of smoking.”11 In other words, a high omega-6 to omega-3 fatty acid ratio would counteract the impact of an increased omega-3 fatty acid intake and make the results difficult to interpret. The reason omega-6 fatty acids counteract the effects of the omega-3 fatty acids relates to the production of eicosanoids (prostaglandins, thromboxanes, and leukotrienes) from omega-6 fatty acids. Chronic excessive production eicosanoids derived from omega-6 fatty acids is associated with an increased risk heart attacks, thrombotic stroke, arrhythmia, arthritis, osteoporosis, inflammation and cancer. The overall benefits of a higher intake of omega-3 fatty acids appears to be related to reducing the omega-6 to omega-3 fatty acid ratio and availability of omega-6 fatty acids for eicosanoid synthesis.

Final Comments

The bottom line is that a pharmaceutical grade fish oil supplement is one of the key foundation formulas for good health. In fact, the development of these high quality fish oil products is one of the major developments in nutritional medicine. In previous newsletters and throughout my website I have continually stressed the importance of supplementing the diet with these long-chain omega-3 fatty acids. Based upon the totality of research, in order to significantly promote health and reduce the risk for cardiovascular disease the daily dosage of EPA and DHA combined should be at least 1,000 mg per day.

The specific product that I recommend is RxOmega-3 Factors from Natural Factors. It is one of the few fish oil products that truly is a pharmaceutical grade product. Each capsule provides 400 mg of EPA and 200 mg of DHA - the exact ratio used in so many of the clinical studies. So, two capsules daily easily achieve the recommended dosage.

Key references:

  1. Hooper L, Thompson RL, Harrison RA, et al. Risks and benefits of omega 3 fats for mortality, cardiovascular disease, and cancer: systematic review. BMJ. 2006;332:752-60.
  2. Hooper L, Riemersma R, Durrington P, et. Al. Authors' reply - omega 3s and health. April 7, 2006.
  3. He K, Song Y, Daviglus ML, Liu K, Van Horn, L, Dyer AR, Greenland P. Accumulated evidence on fish consumption and coronary heart disease mortality: a meta-analysis of cohort studies. Circulation 2004;109:2705- 11.
  4. Whelton SP, He J, Whelton PK, Muntner P. Meta-analysis of observational studies on fish intake and coronary heart disease. Am J Cardiol 2004;93:1119-23.
  5. Bucher HC, Hengstler P, Schindler C, Meier G. N-3 polyunsaturated fatty acids in coronary heart disease: a meta-analysis of randomized controlled trial. Am J Med 2002:112:298-304. 4. Burr ML, Ashfield-Watt PA, Dunstan FD, Fehily AM, Breay P, Ashton T, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. European Journal of Clinical Nutrition 2003;57:193- 200.
  6. Burr ML, Ashfield-Watt PA, Dunstan FD, et al. Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr. 2003; 57:193-200.
  7. Effects of omega-3 fatty acids on cardiovascular disease.
  8. Albert CM, Campos H, Stampfer MJ, et al. Blood levels of long-chain n-3 fatty acids and the risk of sudden death. N Engl J Med. 2002;346(15):1113-8.
  9. Guallar E, Sanz-Gallardo MI, van't Veer P, Bode P, et al. Mercury, fish oils, and the risk of myocardial infarction. N Engl J Med 2002;347:1747-54.
  10. Bemelmans WJ, Broer J, Feskens EJ, et al. Effect of an increased intake of alpha-linolenic acid and group nutritional education on cardiovascular risk factors: the Mediterranean Alpha-linolenic Enriched Groningen Dietary Intervention (MARGARIN) study. Am J Clin Nutr. 2002 Feb;75(2):221-7.
  11. Tribole EF. Excess Omega-6 Fats Thwart Health Benefits from Omega-3 Fats. March 27, 2006.