Hayley Rausch

Nutrition 417
Fall 2015
Omega-3 Fatty Acid Supplements
Introduction:
Omega-3 fatty acids are a class of essential fatty acids that have become one of
the most popular supplements on the market, commonly found in the form of fish oil.
7.8% of American adults reported using Omega-3 supplements in 2012, representing a
two-fold increase since 2007. A wide variety of health benefits have been associated
with high dietary intake of these fatty acids, particularly protection from cardiovascular
disease. The American Heart Association recommends eating two servings of fatty fish
per week to receive the protective effects; however, literature regarding supplementation
of Omega-3s and fish oil is very inconsistent. This review aims to investigate the
scientific basis of the advertised health claims including cardiovascular protection, antiinflammatory effects, and improved cognition and mental health.
Rational for Omega-3 Supplementation:
Omega-3 supplements are recommended based on the rates of deficiency in
America, and the various debated benefits. The typical diet in the U.S. is believed to
have low levels of Omega-3s and high levels of Omega-6s, another essential fatty acid.
While these are both essential nutrients, it is recommended to have a higher ratio of
Omega-3s due to their anti-inflammatory mechanisms and protective effects on the
cardiovascular system. According to the Omegavia supplement website, taking one of
their fish oil pills daily will benefit almost every system in your body. Omegavia promises
that the proven benefits include: protection of the cardiovascular system, comforting of
joints, improved cognitive function and mood, maintaining good eyesight, maintaining
supple and elastic skin, decreased triglycerides, decreased blood pressure, and aiding in
weight loss (Kutty, 2010). Omegavia is a pharmaceutical grade fish oil supplement that is

meant to contain a clinically effective dose for lowering high triglycerides and contain
much more Omega-3s than someone could eat of fatty fish. The main argument for fish
oil supplements is that most people do not get adequate Omega-3s in their diet, and
supplements can increase compliance in people prescribed high doses of Omega-3s.
Health Claims:
Fish oil supplements are touted as a cure for many different diseases and issues.
The main claims include cardiovascular system benefits and protection from disease,
reduction of inflammation, and improvement of mental health. The current research is
divided between small improvements, significant improvements, and no improvements at
all.
The strongest evidence for the benefit of Omega-3 supplements is related to
protection from heart attack and stroke. The GISSI-Prevenzione Investigators found a
supplemented 1g per day of Omega-3s resulted in a significant decrease in death, nonfatal myocardial infarction, and stroke (1999). This study included 11,324 patients who
had recently experienced myocardial infarction and followed them for 3-5 years. The
follow-up concluded that the Omega-3 intervention group had a 10-15% reduced risk of
disease (GISSI-Prevenzione Investigators, 1999). The Omegavia webpage cites a
review of 38 articles regarding the importance of Omega-3s for cardiovascular health
and development in infancy. This review concluded that Omega-3 fatty acids are
significantly involved in almost every aspect of cardiovascular disease, and fish oil
supplements specifically benefit those with high triglyceride levels (Connor, 2000). One
drawback of this review is that the author did not specify how or why the information was
retrieved, leaving a large area for bias.
Other research has found no benefits on cardiovascular health. Rizos et al
collected 20 different studies with a total of 68,680 subjects and found no advantageous
relationship between Omega-3 supplements and risk of all-cause mortality, cardiac

death, sudden death, myocardial infarction, or stroke (2012). This was a very large
meta-analysis, and the fact that they found no effect shows the major discrepancies
between research studies.
The anti-inflammatory properties of dietary Omega-3s in the body have been
well studied, but the efficacy of supplements is not strongly supported. When given high
doses of fish oil ranging from 3-6 grams per day with an additional multivitamin,
participants markers of oxidative stress were significantly reduced (Pipingas et al,
2015). Oxidative stress markers can be predictive of developing cardiovascular disease,
so this showed a positive effect. However there were no changes between groups
receiving fish oil and the placebo in respect to inflammatory biomarkers (Pipingas et al,
2015). Another trial of healthy subjects compared the nutritional dose of .85 grams per
day against the pharmaceutical dose of 3.4 grams per day and their effects on
inflammatory markers (Skulas-Ray, 2011). Overall they found no benefits of either dose
on inflammation, which is surprising because 6g per day is a very high dose.
Omega-3 fatty acids are believed to play a part in brain function, which has led to
studies focusing on cognitive ability and mental health. Witte et al investigated
prevention of cognitive decline in an elderly population through fish oil supplementation
(2014). After taking 2.2 grams of Omega-3s per day, the participants experienced a 26%
increase in cognitive function and increases in both white and grey matter of the brain
(Witte et al, 2014). This is one of the most promising studies related to cognition and
Omega-3 supplements, but the sample size was relatively small (n=60) which could
have skewed the results. When looking at mental health conditions like schizophrenia
and depression, fish oil supplements may be helpful in some cases and not others. In
regard to schizophrenia, a dose of 1.2 grams per day reduced patients risk of psychosis
by 23% while also reducing the positive, negative, and general symptoms of
schizophrenia (Amminger et al, 2010). Depression is hypothesized to be partially caused

by inflammation in the body and brain. Thus, Omega-3s have been studied in the
treatment of depressed individuals, with mostly inconclusive results. For example
Rogers et al cites studies showing small improvements in depressed people, however in
their own study with fish oil doses of 1.5 grams per day they found no improvements in
depressive symptoms or cognitive functioning (2008). Once again the results of these
studies are very contradictory and mostly inconclusive.
Supplement Use:
While Omega-3 supplements are effective in terms of bioavailability, this may be
hindered by other factors. One of the most important considerations is the competition
between pathways of Omega-3 fatty acids and Omega-6 fatty acids. Research has
shown that when subjects are put on a low Omega-6 diet, their Omega-3 levels increase
without any further supplementation (Taha et al, 2014). This should be considered when
someone is beginning to take an Omega-3 supplement, and they may need to lower the
amount of Omega-6s in their diet in order to receive the full effects.
Additionally, the absorption of Omega-3 supplements may differ by the type.
Supplements found in the re-esterified triglyceride form were found to be most effective,
followed by natural fish oil, and lastly ethyl ester fish oil (Dyerberg et al, 2010). Omega-3
supplements should also be taken with a high fat meal, as this has been shown to
increase uptake (Dyerberg, et al 2010).
Fish Oil vs. Food:
The health benefits of consuming fatty fish have been well documented, but the
positive effects of fish oil supplements are less convincing. However some research has
found equal positive effects on blood lipids from eating fish and from fish oil (Cobiac et
al, 1991). These findings are very interesting and give reason for further studies. When
comparing a pharmaceutical grade Omega-3 supplement like Omegavia and a food
source like salmon (Table 1), it is clear you can easily get the same amount of Omega-3

fatty acids from one dose or serving of each. The issue lies in the cost, since it costs
$0.58 to $1.16 to take 1-2 soft gels of the supplement and $4.47 for one serving of
salmon. Then if the supplement or food is to be taken every day of the week, that adds
up to $4.06 or $8.12 for the soft gels and $31.29 for the salmon.

Food

Suppleme
nt

[a] Name Food

and Supplement

[b]
Amoun
t

Wild skinless,
boneless sockeye
salmon (canned)

3.5
ounces

Fish Oil Soft Gel

(Pharmaceutical
grade, Omegavia
brand)

1-2 soft
gels

[c] Cost
per
serving or
dose.
$7.67 per
can
$4.47 per
3.5 ounce
serving
$34.69/60
pills
containing

[d] Amount (g) of active

ingredient in the designated
serving size of food
1,500mg total Omega-3 per
serving.

1120-2210mg total Omega-3

per dose.

$0.58$1.16/dose
Table 1: Comparison of Omega-3 fatty acids in fish oil and fatty fish

Discussion:
There may be specific cases when Omega-3 supplements prove beneficial, but
the general public should be advised to follow current dietary recommendations for fatty
fish. If adequate Omega-3s are not being eaten, a moderate dose fish oil supplement
will most likely not be harmful and possibly provide slight health benefits. While the
current literature does not provide substantial proof of these benefits in healthy people, it
is established that low levels of Omega-3s can be detrimental to health. People with
hyperlipidemia or those who have recently suffered a myocardial infarction or stroke may
benefit from a pharmaceutical dose of Omega-3 supplements. Future research will help
further illustrate the effects of Omega-3 supplements on mental health, however the

current literature is promising and suggestive that there may be significant benefits.
Taking things like fish oil over a long term period will not be harmful, unless the fish oil is
contaminated or is taken at too high of a dose. Individuals should assess their needs
with a physicians guidance and always research which brand of supplements are the
safest. In conclusion I would recommend consuming Omega-3 fatty acids by including
more fatty fish in the diet. However, if this is not possible due to cost or dislike of fish, a
moderate dose fish oil supplement may prove to have some health benefits down the
road.

References
1. Kutty V. Fish Oil Benefits and Your Health. Internet: http://omegavia.com/fish-oilbenefits/
2. GISSI-Prevenzione Investigators. Dietary supplementation with n-3 polyunsaturated
fatty acids and vitamin E after myocardial infarction: results of the GISSIPrevenzione trial. The Lancet 1999;354:447-455
3. Connor WE. Importance of n-3 fatty acids in health and disease. Am J Clin Nutr
2000;71(suppl):171S-175S
4. Rizos EC, Ntzani EE, Bika E, Kostapanos MS, Elisaf MS. Association Between
Omega-3 Fatty Acid Supplementation and Risk of Major Cardiovascular Disease
Events: A Systematic Review and Meta-analysis. JAMA 2012;308:1024-1023
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Grima NA, Stough C, Scholey A, Myers SP, Sali A, Pase MP. Fish oil and
multivitamin supplementation reduces oxidative stress but not inflammation in
healthy older adults: A randomisedcontrolled trial. J Funct Foods 2015;19:949957
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SG. Dose-response effects of omega-3 fatty acids on triglycerides, inflammation,
and endothelial function in healthy persons with moderate hypertriglyceridemia.
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Structure in Older Adults. Cereb Cortex 2014;24:3059-3068
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Gen Psychiatry 2010;67:146-154
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A, Ramsden CE. Dietary omega-6 fatty acid lowering increases bioavailability of
omega-3 polyunsaturated fatty acids in human plasma lipid pools. Prostaglandins
Leukot Essent Fatty Acids 2014;90:151-157
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hemostatic effects of fish vs fish-oil n-3 fatty acids in mildly hyperlipidemic males.
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