• Docosahexaenoic Acid (DHA), Eicosapentaenoic Acid (EPA), Omega-3 Fatty Acids, Omega-3 Oil(s)
Fish oil contains omega-3 fatty acids, one of the two main classes of essential fatty acids. (
Interest in the potential therapeutic benefits of omega-3 fatty acids began when studies of the Inuit (Eskimo) people found that, although their diets contain an enormous amount of fat from fish, seals, and whales, they seldom suffer heart attacks. This is presumably because those sources of fat are very high in omega-3 fatty acids.
Subsequent investigation found that the omega-3 fatty acids found in fish oil have various effects that tend to reduce risk of heart disease and strokes. However, research into whether use of fish oil actually prevents these diseases, while somewhat positive, remains incomplete and somewhat inconsistent. In recognition of this, the FDA has allowed supplements containing fish oil or its constituents to carry a label that states: "Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease."
In addition, a slightly modified form of fish oil (ethyl-omega-3 fatty acids) has been approved by the FDA as a treatment for
Fish oil has also shown promise as an anti-inflammatory treatment for conditions such as rheumatoid arthritis, menstrual pain, and lupus. In addition, it may be helpful for various psychiatric conditions.
There is no daily requirement for fish oil. However, a healthy diet should provide at least 5 g of essential fatty acids daily.
Many grains, fruits, vegetables, sea vegetables, and vegetable oils contain significant amounts of essential omega-6 and/or omega-3 fatty acids, but oil from cold-water fish is the richest natural source of omega-3 fats. It is commonly stated that people require a certain optimum ratio of omega-3 to omega-6 fatty acids in the diet; however, there is no real evidence that this is true, and some evidence that it is false. 231
Typical dosages of fish oil are 3 g to 9 g daily, but this is not the upper limit. In one study, participants ingested 60 g daily.
The most important omega-3 fatty acids found in fish oil are called eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In order to match the dosage used in several major studies, you should take enough fish oil to supply about 2 g to 3 g of EPA (2,000 mg to 3,500 mg) and about 1.0 g to 2.5 g of DHA daily (1,000 mg to 2,500 mg). Far higher doses have been used in some studies; conversely, one study found blood-pressure lowering effects with a very low daily dosage of DHA—0.7 g. 238
DHA and EPA are not identical and might not have identical effects. Some evidence hints that DHA may be more effective than EPA for thinning the blood
Some manufacturers add vitamin E to fish oil capsules to keep the oil from becoming rancid. Another method is to remove all the oxygen from the capsule.
If possible, purchase fish oil products certified as free of significant levels of mercury, toxic organochlorines, and PCBs (see Safety Issues).
Flaxseed oil also contains omega-3 fatty acids, although of a different kind. It has been suggested as a less smelly substitute for fish oil. However, it is far from clear whether flaxseed oil is therapeutically equivalent to fish oil.
Consumption of fish oil alters the body’s production of certain substances in the class of chemicals called prostaglandins. Some prostaglandins increase inflammation while others decrease it. The prostaglandins whose production is enhanced by fish oil fall into the anti-inflammatory category. Based on this, fish oil has been tried as a treatment for early stages of rheumatoid arthritis
Fish oil’s apparent anti-inflammatory properties are the likely explanation for its apparent benefit in
Incomplete evidence hints but does not prove that fish or fish oil might help prevent death caused by
For a number of theoretical reasons, it has been suggested that fish oil and its constituents (especially a slightly modified form of EPA called ethyl-EPA) might have positive effects on various psychiatric disorders. However, the best studied use of fish oil-related products for
Small studies also suggest that fish oil may be helpful in
According to some, but not all studies, fish oil may help treat the
Use of fish oil by
Intriguing, but not yet at all reliable, evidence hints that fish oil, or its constituents, might be helpful for treating
One study found that insulin metabolism in 278 young, overweight subjects improved on a calorie-restricted diet rich in fish oil from seafood or supplements compared to those on a diet low in fish oil, suggesting that fish oil may help delay the onset of
Some, but not all, studies suggest that fish oil combined with
For several other conditions, the current balance of the evidence suggests that fish oil is not effective.
For example, despite widely publicized claims that fish oil helps
Similarly, a 16-week, double-blind, placebo-controlled study of 167 individuals with recurrent
One study found weak evidence that use of fish oil might decrease aggressive behavior in young girls (but, in this study, not in young boys).
Fish oil is also sometimes recommended for enhancing immunity in
In one large, randomized, controlled trial, diets rich in fish and
Preliminary studies have suggested that fish oil could help symptoms of
One study failed to find fish oil more effective than placebo for treating
Use of essential fatty acids in the omega-3 family has also shown some promise for the treatment of non-alcoholic fatty liver.
What Is the Scientific Evidence for Fish Oil?
Heart Disease Prevention
Studies on fish or fish oil for preventing cardiovascular disease, slowing the progression of
, and preventing heart-related death have returned somewhat contradictory results.
A gigantic study (over 18,000 participants) published in 2007 was widely described in the media as finally proving beyond a shadow of a doubt that fish oil helps prevent heart problems.
As noted earlier, fish oil is hypothesized to exert several separate effects that act together to help protect the heart. The most important action of fish oil may be its apparent ability to reduce
Fish oil has been specifically studied for reducing triglyceride levels in people with
Some but not all studies suggest that fish, fish oil, or EPA or DHA separately may additionally raise the level of HDL ("good") cholesterol and possibly improve other aspects of cholesterol profile as well.
Studies contradict one another on whether fish oil can lower
Evidence is conflicting on whether fish oil helps prevent heart arrhythmias.
Fish oil may slightly reduce heart
The results of numerous small double-blind trials indicate that omega-3 fatty acids in fish oil can help reduce the symptoms of
Regular use of fish oil may reduce the pain of
In a 4-month study of 42 young women aged 15 to 18, half the participants received a daily dose of 6 g of fish oil, providing 1,080 mg of EPA and 720 mg of DHA daily.
Another double-blind study followed 78 women, who received either fish oil, seal oil, fish oil with vitamin B
(7.5 mcg daily), or placebo for three full menstrual periods.
A 4-month, double-blind, placebo-controlled study of 30 individuals suggests that fish oil can enhance the effects of standard treatments for
Another small study found that ethyl-EPA (a modified form of EPA) is helpful for the depressive phase of bipolar disease.
A 4-week, double-blind, placebo-controlled trial evaluated the potential benefits of fish oil in 20 individuals with
A double-blind, placebo-controlled study of 70 people who were still depressed despite standard therapy (such as
Additionally, a small preliminary study of women found that fish oil was significantly more effective than placebo at alleviating post-partum depression.
In small, double-blind studies, fish oil has been found to reduce the severe finger and toe responses to cold temperatures that occur in
There is some evidence that essential fatty acids may enhance the effectiveness of calcium in
However, a 12-month, double-blind trial of 42 postmenopausal women found no benefit.
The explanation for the discrepancy may lie in the differences between the women studied. The first study involved women living in nursing homes, while the second studied healthier women living on their own. The latter group of women may have been better nourished and already received enough essential fatty acids in their diet.
Attention Deficit and Hyperactivity Disorder (ADHD)
Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs have been tried for the treatment of
A preliminary double-blind, placebo-controlled trial found some evidence that a supplement containing fish oil and
In a double-blind, placebo-controlled trial of children already using stimulant therapy, addition of DHA for 4 months failed to further improve symptoms.
Fish oil appears to be generally safe. The most common problem is fishy burps. However, there are some safety concerns to consider.
For example, it has been suggested that some fish oil products contain excessive levels of toxic substances such as organochlorines and PCBs. 166
Fish oil has a mild blood-thinning effect; in one case report, it increased the effect of the blood-thinning medication warfarin (Coumadin).
Fish oil does not appear to raise blood sugar levels in people with diabetes.
Fish oil may also raise the level of LDL ("bad") cholesterol; it is possible, however, that this effect may be short-lived, and that levels return to normal with continued use.
If you decide to use cod liver oil as your fish oil supplement, make sure you do not exceed the safe maximum intake of
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104. Whelton PK, Kumanyika SK, Cook NR, et al. Efficacy of nonpharmacologic interventions in adults with high-normal blood pressure: Results from phase 1 of the Trials of Hypertension Prevention. Am J Clin Nutr. 1997;65(suppl 2):S652-S660.
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119. Angerer P, Stork S, Kothny W, et al. Effect of marine omega-3 fatty acids on peripheral atherosclerosis in patients with coronary artery disease—a randomised 2 year intervention trial [abstract]. Eur Heart J. 2001;22(suppl):162.
121. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA. 1995;274:1363-1367.
125. Nilsen DW, Albrektsen G, Landmark K, et al. Effects of a high-dose concentrate of n-3 fatty acids or corn oil introduced early after an acute myocardial infarction on serum triacylglycerol and HDL cholesterol. Am J Clin Nutr. 2001;74:50-56.
136. Bassey EJ, Littlewood JJ, Rothwell MC, et al. Lack of effect of supplementation with essential fatty acids on bone mineral density in healthy pre- and postmenopausal women: two randomized controlled trials of Efacal v. calcium alone. Br J Nutr. 2000;83:629-635.
140. Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry. 2002;26:233-239.
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Last reviewed June 2008 by EBSCO CAM Review Board
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