Reading a fish oil supplement label can be a daunting task. Understanding the difference between DHA and EPA, the active ingredients in fish oil, is even more complex. The reason for this complexity resides in the fact that our understanding of these two fatty acids is in its infancy. Still, let’s try to make some sense of what we’ve learned over the past decade or so.

Fatty acids are comprised of just three different atoms, carbon (the long backbone or skeleton of the fatty acid), hydrogen, and oxygen.  That’s it. The difference among the various fats lies in the length of the backbone (how many carbon atoms there are) and the number of “double bonds” between carbon atoms. Other than these two distinctions, the fatty acids are really the same. So, then why are there such great differences among the fats if they’re so similar, you might ask? It turns out that longer chains tend to be more biologically active, and more double bonds results in more twisted and misshapen molecules which can then take on characteristics akin to complex locks or keys. As signaling and communication between cells often occurs through a lock and key mechanism, the fatty acids with many double bonds turn out to be great candidates for this task.

EPA is shorter than DHA (perhaps a bit less biologically active) and has fewer double bonds (less effective as a lock or key). EPA tends therefore to serve more as a precursor for other molecules that can diminish inflammation, clotting, oxidation, and cell death. DHA is also a precursor for some wonderful molecules that cause reversal of inflammation and tremendous protection of nerve tissue. Additionally, DHA is actively incorporated in our cell membranes where it can help cells communicate with other cells.

Other attributes shared by these two omega-3s include: Lowering triglycerides; raising HDL: and lowering the risk of lethal heart rhythms during and following heart attacks. Our bodies contain far more DHA than EPA, and DHA lasts longer in our bodies than does EPA, but both of these fatty acids have very important roles to play, and should be emphasized in our diets.

So, now that you understand the different forms that fish oils come in, it would be helpful to know what you’re putting in your mouth when you swallow a fish oil soft gel.  To do this, you have to develop the skill of label-reading.  At first blush this may seem to be a simple task, one not worthy of a blog, but in truth deciphering labels can at times be anything but easy.  I am not suggesting that companies intentionally mislead consumers with marketing and catchy phraseology, but at times they certainly don’t go out of their way to clarify what’s being sold to you.  For instance, what does it mean when a label catches your attention with the bold statement, “1,000 mg of fish oil”? Are you to be comforted knowing that taking just one of these pills meets the American Heart Association’s recommendation for heart patients to take 1,000 mg of the essential omega-3s EPA+DHA daily? More often than not, the answer is NO.  That’s because fish oil does not equal EPA+DHA.  And it’s EPA+DHA that you’re after.  EPA and DHA are the active and beneficial ingredients in fish oil, not the other fats (which include saturated fats as well).  To be sure you are getting what you want and deserve, follow these few steps:

1. Pay attention to only the “Supplement Facts”
2. Read the “Serving size” – how many soft gels does it take to get one serving? Mark that # down.
3. Read the “Amount per serving” – how much EPA is there, and how much DHA is there in a single serving? Add the amounts of EPA + DHA per single serving. Write that # down. Ignore “other omega-3s’ or “Total omega-3s”
4. Let’s say your goal is to get 1,000 mg daily of DHA+EPA. Take “1,000” and divide it by the number you got in step 3. For instance, if the number you arrived at is “500 mg”, then 1,000/500 is 2.  You must take 2 servings to get your 1,000 mg of DHA+EPA daily.
5. But you must be sure how many soft gels make up a single serving! So, now multiply the answer you got in step 4 by the # you got in step 2. For our current example, this will give you the # of pills needed to get your 1,000 mg of DHA+EPA daily. As the serving size can be 1, 2 or even 3 pills, in the case we’ve constructed you might need to take 2, 4, or even six pills to get what you want! That is why this process is so important.

Remember, the more DHA+EPA there is per gram of fish oil, the more concentrated and pure the oil is.  The more pure the oil, the fewer unnecessary fats you are consuming.  Try to get the purest oils. Extra fat gives you extra and unnecessary calories, something most of us do not need these days.

I hope this has been clear and helpful for you. The next blog, Differentiating Fish Oils Part 3, will discuss the different ways our bodies utilize DHA and EPA.

This series will succinctly describe various aspects of the omega-3 fish oils that cause doctors and their patients a great deal of confusion and consternation. We will begin with the form of the oil.

Fish oils come in four forms: Ethyl Ester (EE), Triglyceride (TG), Phospholipid (PL), and Free Fatty Acid (FFA). Most fish oils (including the prescription, Lovaza) come in the EE form.  In fact, the largest and most profound scientific studies to date have used EE omega-3s.  In nature, omega-3s are found in the TG and PL forms.  The problem is that in order for manufacturers to develop pills with highly concentrated important omega-3s, EPA and DHA (also known as the active ingredients in fish), they must first convert the omega-3s to the EE form.  Then these health-promoting omega-3s can be highly concentrated, and depending upon one’s preference, either EPA or DHA can be emphasized (to be discussed in a future blog). Some manufacturers chose to convert the oils back to the TG form (a process that requires the oils to be subjected to high temperatures for long periods of time – not good for the oils in some experts’ opinions).  Others convert the oils into the FFA form to try to enhance absorption.  The Krill oil producers leave the oil in its original PL form with the drawback being that only very small amounts of the key ingredients EPA and DHA can be delivered in each pill.  The Krill and TG contention is that these forms of omega-3s are more “natural” and thus better.  The reality is, however, that all the oils must be changed in our gut to FFA in order to be absorbed.  Thus, they are no longer PL, TG, or EE when they’re absorbed by our bodies.  They are all FFAs. Studies to date have shown this conversion to be an efficient process and up to 95% absorption can be expected when any of the forms are taken with food. In fact, the lion’s share of the current literature indicates that the form of the oil is probably not nearly as important as companies would like you to believe. The most important issue is how much EPA and DHA you are receiving when you swallow a pill or eat a fish.  That is what you need to look for (also the subject of another blog).

Fats are divided into three categories:  the good (monounsaturated and polyunsaturated), the bad (saturated), and the just plain awful (trans fats).   In the good group are the omega-3s: DHA (docosahexaenoic acid), EPA (eicosapentaenoic acid), and ALA (alpha-linolenic acid).  All three are good for you, but evidence for a health protective role is strongest for the DHA and EPA found in fish and fish oils.  ALA found in flax seeds, which is derived from plants, is less and only indirectly beneficial if you are trying to boost your omega-3s because the body uses most of it for energy and metabolizes only a small amount of ALA into EPA and DHA.

The omega-3 fatty acid DHA is one of the most abundant fatty acids in the brain. In the fetus and young infants, DHA is essential for proper growth and development of the brain, nervous system, and the retina of the eye. The richest dietary sources of DHA are the oils from cold-water fish such as salmon, mackerel, herring, sardines, and other marine animals.

Both DHA and EPA have since been studied in myriad trials and if there is any panacea out there it appears that they may just be it.  Scientific evidence indicates that the omega-3 fatty acids, DHA + EPA, have natural anti-inflammatory properties and may have potential benefits in the prevention and/or treatment of the following health conditions:

• Alzheimer’s and other cognitive diseases
• Asthma
• Attention deficit hyperactivity disorder (ADHD)
• Bipolar disorder and Depression
• Cancer
• Cardiovascular disease
• Crohn’s disease and Ulcerative colitis
• Diabetes
• Eczema and Psoriasis
• High blood pressure
• Lupus
• Joint disease including Rheumatoid arthritis and Osteoarthritis
• Macular Degeneration
• Migraine headaches
• Multiple sclerosis (MS)
• Obesity