What is Fish Oil? Fish oil is a major source of omega-3 fatty acids (FAs) found naturally in fatty fish. It is composed of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). The preferred dose ratio of a one gram capsule of fish oil is 480 mg EPA and 370 mg DHA.
Why is Fish Oil Important? Fish oil is used to lower triglycerides (TG) level in humans to promote a healthy heart. Fish oil has also been shown to aid the treatment of rheumatoid arthritis and depression in some patients. Fish oil has been shown to decrease intestinal cholesterol absorption and prevent the formation of low-density lipoproteins (VDLDs) as well as decreasing other lipoproteins.
What is the Daily Dose? In general, the recommended dose is 1-2 grams per day. When used as an aid in the treatment of hyperlipidemia the dose is 2-4 grams per day in divided doses. A product labeled as 1 gram fish oil containing 250 mg EPA and 180 mg DHA per capsule is considered to be inadequate and may be avoided. DHA/EPA products derived from algae are also available for vegetarians. Enteric-coated products are also available.
Safety: Fish oil capsules are considered safe with few side effects. G-I distress and belching with fishy halitosis has been reported. Capsules should be taken with meals or at bedtime to prevent the occasional “fish burp.” Freezing the capsules may be helpful. Daily doses more than 4 grams a day may increase the risk of bleeding but evidence is limited. Patients taking any anti-thrombotic agents (aspirin or warfarin are examples) should use no more than 3 grams daily and be monitored for bruising.
Disease Prevention: According to the 2017 American Heart Association Science Advisory Committee, two groups of patients most likely to benefit from being treated with fish oil include patients being treated for cardiovascular disease (CVD) and patients being treated for heart failure (HF). Clinical studies demonstrating using 1 gram of fish oil for primary prevention of CVD in healthy individuals have not demonstrated risk reduction in older adults.
Buyer Beware: Any questions you may have about using fish oil should be directed to your health care provider or pharmacist before purchasing to determine safety and to determine if the product is right for you. There are many fish oil products available to the consumer and fish oil is not regulated by the Food and Drug Administration (FDA). Always choose a high-quality product. Before choosing, read the label carefully to be sure the product contains the correct labeled contents. Buy the best. Leave the rest.
Keith Miller, Pharm.D.