Most of us are not ingesting the right kinds of fatty acids, the ones found in fish and fish oils. If you do not consume fish at least once or twice a week, you are likely to notice health benefits from taking these omega-3 fatty acid supplements. Those who are vegetarian may obtain omega-3 fatty acids such as alpha linolenic acid from flax oil. ALA is able to convert into longer fatty acids EPA and DHA, but it is possible that the ability of the body to convert shorter chained fatty acids such as ALA into longer chained fatty acids such as EPA and DHA may decrease with age. Another option for vegetarians is to consume DHA fatty acid derived from algae. These are available as DHA supplements.
   Towards the bottom of the page you will find a discussion of fish oil side effects. Krill oil supplements are also helpful.

Supplements over the counter
Fish oil supplements are dietary supplements that contain oil from the flesh of cold water fish such as mackerel, salmon, black cod, albacore tuna, sardines, and herring. The active ingredients in fish oil supplements are essential fatty acids known as omega-3 fatty acids. They typically include eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Most fish oil capsules or pills are obtained from the flesh of fish. In contrast, fish liver oils are derived from the livers of white fish, such as cod and halibut. Fish liver oils contain vitamins A and D and may have a different concentration of EPA and DHA than fish oils derived from flesh.

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Supplements of fish oils that contain EPA and DHA are sold over the counter. DHA is also sold by itself. In the body, DHA is found mostly in the brain, retina, and in sperm. At this time I don't see a need to take DHA by itself. It's much cheaper and perhaps better to take both EPA and DHA together. Fish oil pills come in a variety of dosages. Common fish oil capsules include about 100 to 200 mg each of DHA and EPA. If you have a diet high in fish, you would not need to take any fish oil capsules. Those who don't eat fish may benefit by taking one to four fish oil capsules a day.

Benefits for the mind and body
Fish and fish oils have benefits in a variety of medical conditions. These fatty acids are converted by the body into the beneficial series 3 prostaglandins. Fish oil, rich in anti-inflammatory omega-3 fatty acids and derived from oily fish such as tuna, salmon and mackerel -- is already recommended by the American Heart Assn. to help prevent cardiovascular disease. It has been shown to reduce blood triglyceride levels and slightly lower blood pressure, lowering the risk for heart attacks and strokes. Below we list several medical and psychiatric conditions where fish oils supplements could be of benefit.

Alzheimer's disease
It appears Omega-3 fatty acids are able to help patients who have mild Alzheimier's disease. Since current drugs used for Alzheimer's disease are not very helpful, and potentially dangerous, perhaps doctors should initially try omega-3 fatty acids in mild cases of AD rather than cholinesterase inhibitors.

Omega-3 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegAD study: a randomized double-blind trial.
Arch Neurol. 2006. Department of Neurobiology, Section of Clinical Geriatrics, Karolinska University Hospital Huddinge, Stockholm.
Epidemiologic and animal studies have suggested that dietary fish or fish oil rich in omega-3 fatty acids, for example, docosahexaenoic acid and eicosapentaenoic acid, may prevent Alzheimer disease (AD). Two hundred four patients with AD whose conditions were stable while receiving acetylcholine esterase inhibitor treatment and who had a Mini-Mental State Examination (MMSE) score of 15 points or more were randomized to daily intake of 1.7 g of docosahexaenoic acid and 0.6 g of eicosapentaenoic acid (omega-3 fatty acid-treated group) or placebo for 6 months, after which all received omega-3 fatty acid supplementation for 6 months more. Administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline according to the MMSE or the cognitive portion of the Alzheimer Disease Assessment Scale. However, positive effects were observed in a small group of patients with very mild AD.

Anxiety benefit
Fish oil supplement use may slightly reduce symptoms of anxiety.

Bipolar disorder
I am bipolar and i was reading about how fish oil pills may help with my disorder, i am type two which is the milder of the two and i am not suicidal. I was taking lithium but i am looking for something more natural. What would be the recommended number of fish oil pills. i realize that you are not my doctor and i should only take what my doctor perscribes.
   It is difficult to predict in any one person whether fish oils would help with the bipolar disorder and if it does how many softgels would be required. Under medical supervision a person can start with 3 softgels and gradually increase over time as needed.

Brain health
Increasing consumption of fish oil is associated with greater gray matter volume in nodes of a corticolimbic circuitry supporting emotional arousal and regulation. This may lead to better memory and mood.
     
Depression and low mood
Depressed patients who are given high doses of fish oil supplements experience a decrease in their symptoms, such as sadness, anxiety and sleeping problems.

Fish oil for depression, compared to fluoxetine also known by the brand name Prozac
Comparison of therapeutic effects of omega-3 fatty acid eicosapentaenoic acid and fluoxetine, separately and in combination, in major depressive disorder.
Aust N Z J Psychiatry. 2008.
To compare therapeutic effects of eicosapentaenoic acid, fluoxetine and a combination of them in major depression. Sixty outpatients with a diagnosis of major depressive disorder were randomly allocated to receive daily either 1000 mg EPA or 20 mg fluoxetine, or their combination for 8 weeks. EPA plus fluoxetine combination was significantly better than fluoxetine or EPA alone from the fourth week of treatment. Fluoxetine and EPA appear to be equally effective in controlling depressive symptoms. In the present 8 week trial EPA and fluoxetine had equal therapeutic effects in major depressive disorder. EPA and fluoxetine combination was superior to either of them alone.

Fish oil supplements and exercise, physical activity
Fish oil reduces heart rate and oxygen consumption during exercise.
J Cardiovasc Pharmacol. 2008.
Dietary omega-3 polyunsaturated fatty acids (PUFAs) are readily incorporated into heart and skeletal muscle membranes where, in the heart, animal studies show they reduce O2 consumption. To test the hypothesis that omega-3 PUFAs alter O2 efficiency in humans, the effects of fish oil supplementation on O2 consumption during exercise were evaluated. Sixteen well-trained men (cyclists), randomly assigned to receive 8 x 1 g capsules per day of olive oil (control) or fish oil for 8 weeks The fish oil supplementation lowered heart rate (including peak heart rate) during incremental workloads to exhaustion. In addition, the fish oil supplementation lowered steady-state submaximal exercise heart rate, and whole-body O2 consumption. Time to voluntary fatigue was not altered by fish oil supplementation. This study indicates that fish oils may act within the healthy heart and skeletal muscle to reduce both whole-body and myocardial oxygen demand during exercise, without a decrement in performance.

Benefit of fish oils for heart disease treatment or prevention
Fish oil supplements reduce the risk for heart disease by improving circulation, improving the function of the endothelium, the inner lining of arteries, reduce the risk of heart arrhythmias. Fish oils are rapidly incorporated into human heart cell phospholipids at the expense of arachidonic acid. This may lead to a reduction of arrhythmias or heart palpitations.

Benefit of fish oil to reduce the risk of sudden death
Increasing dietary omega-3 fatty acids from fish oils and decreasing omega-6 fatty acids, found in plant seed oils such as corn, safflower, and sunflower, is a way to reduce the risk of sudden death from irregular heart rhythms or heart attacks.
   One cause of sudden death is ventricular fibrillation, in which the heart contracts in a fast and chaotic rhythm that makes it unable to pump blood to the rest of the body. A number of factors including cigarette use, fasting, diabetes, hyperthyroidism or heart attack can trigger the release of fatty acids from adipose tissue.
   Fats that we eat are stored in adipose (fat) tissue. When these fats are released from their storage sites, they become free fatty acids. But not all fatty acids are equal in their propensity to cause arrhythmias. High levels of omega-6 fatty acids may encourage arrhythmias if their levels aren’t balanced by omega-3 fatty acids.

Fish oils reduce heart rhythm problems and palpitations
Daily supplementation with fish oils reduces heart rate variability. Heart rate variability measures the variability in the intervals between heartbeats, with lower variability being associated with higher risks of heart disease and death. A normal heart does not always have the same time intervals between beats, but every so often (in cycles) the interval between cardiac beats changes; i.e. a little shorter, or longer. How frequent these variations occur are a measure of the effect of the nervous regulation of the heart. A sick heart losses this fine tuning.

Dr. Glenn D. Young from Royal Adelaide Hospital, Australia has confirmed the consumption of fish oil supplements has the effect of reducing the electrical irritability of the heart in people with heart rhythm disturbances. Several studies have reported a decrease in risk of sudden cardiac death or cardiac arrest with increased consumption of fish or fish oils, fueling the idea that fish oil may have heart-rhythm stabilizing, or "anti-arrhythmic" properties. Dr. Glenn D. Young from Royal Adelaide Hospital studied 26 patients suffering from a rapid abnormal heart rhythm called ventricular tachycardia who were having a cardiac defibrillator implanted. Twelve patients consumed 3 grams of fish oil daily for 6 weeks and 14 did not. At an initial electrophysiologic study, the researchers were able to induce ventricular tachycardia through programmed extra stimuli in all 26 patients. At a repeat electrophysiologic study, 42 percent of the fish oil group had no inducible ventricular tachycardia compared with just 7 percent of the control group. American Journal of Cardiology, 2008.

A study in the American Journal of Preventive Medicine, October 2006, tried to estimate the potential public health impact of raising adults' omega-3 levels with fish oil supplements. Using a computer-simulated community of 100,000 Americans and data from past medical studies, the researchers calculated that raising omega-3 levels would save 58 lives each year. This amounts to a 6 percent total death reduction -- mostly by preventing sudden cardiac death in apparently people, according to the study authors, led by Dr. Thomas E. Kottke of the Heart Center at Regions Hospital in St. Paul, Minnesota. Even if automated external defibrillators (AEDs) were available in every home and public area, the devices would lower a community's annual death rate by less than 1 percent. If fish oil is as effective against fatal heart arrhythmias as evidence suggests, it would have more widespread benefits than either AEDs or implanted defibrillators.

Inflammation, benefit as anti-inflammatory fatty acids
A diet high in oily fish like salmon, halibut, and mackerel may help improve inflammatory conditions such as arthritis. A key anti-inflammatory fat in humans is derived from a fatty acid found in fish oil. The researchers, from Harvard Medical School and Brigham and Women's Hospital, found the diet worked best when combined with low aspirin doses. The inflammatory response protects the body against infection and injury, but when it goes wrong it can lead to conditions such as arthritis, and cardiovascular disease. The Harvard team identified a new class of fats in the human body, called resolvins, which they showed can control inflammation. They do this both by stopping the migration of inflammatory cells to sites of inflammation, and the turning on of other inflammatory cells. Resolvins are made from the omega-3 fatty acids, found in high concentration in oily fish. Their production also appears to be stimulated by taking aspirin.

Fish oils and joint problems, arthritis, osteoarthritis
Fish oil supplements may benefit those with joint pain, symptoms of arthritis and certain autoimmune diseases. Fish oils can decrease the severity of ankylosing spondylitis and rheumatoid arthritis. Fish oils may be helpful to people with lupus since fish oils have anti-inflammatory properties.

Prostate cancer prevention
Eating foods rich in omega-3 fatty acids, such as oily fish, and decreasing intake of omega-6 oils, may help prevent the spread of prostate cancer. The types of fats we consume do influence the function of our organs. In laboratory studies, scientists at Christie Hospital in Manchester, England found that fish oils could block the spread of cancerous cells. Omega-6 oils, found in vegetable oils, nuts and seeds, apparently increased the spread of tumor cells into bone marrow. This invasion was blocked by omega 3 fats -- the ones found in oily fish. The researchers believe omega-3 fatty acids interfere with functions of omega-6, which cancer cells may use as a source of energy, and prevent them from spreading beyond the prostate gland. Since most Americans eat a diet which has a much higher proportion of omega-6 fatty acids to omega 3 fats, it is possible that eating more fish, taking fish oil capsules, and reducing intake of omega-6 fats may well help to reduce the spread of prostate cancer cells.

Fish oil and statin drugs used for cholesterol reduction
Adding fish oil supplement pills along with a statin drug such as simvastatin can reduce cholesterol and triglyceride levels.

Sperm health, healthy semen
Fish oils are found in sperm, and these oils may support healthy sexual organ function.

What daily dosage should be taken for depression?
We don't have a standard amount. We evaluate the whole patient, including their diet and lifestyle patterns. We don't use fish oils by themselves, but depending on the person we will use fish oils in combination with 5-HTP or St. John's wort, or SAM-e, or Mind Power Rx, and other supplements. As a general guideline, though, we will use three to five fish oil capsules daily but this varies with the person and their diet. If someone is eating fish more than three times a week, they would not need as many capsules of fish oils compared to someone who does not eat much fish.

Fish oils and pregnancy
In pregnant women with previous pregnancy complications, fish oil supplements delays onset of delivery in low and middle, but not in high, fish consumers.

University of Western Australia researchers gave women fish oil supplements that had 2.2 grams docosahexaenoic acid (DHA) and 1.1 grams eicosapentaenoic acid (EPA) from 20 weeks of gestation until delivery. Compared to the group who receive olive oil, breast milk from women who received fish oil had proportionally higher DHA and EPA levels the first few weeks after delivery. Babies breastfed from mothers who had taken the fish oil supplements were found to have better hand and eye coordination.

Metabolism
Fish oils are made in the body from a fatty acid called alpha-linolenic acid (ALA). ALA is an omega-3 fatty acid found predominantly in flaxseed oil (also known as linseed) and hemp seed oil. Green leafy vegetables, soybeans, walnuts, and canola oil have small amounts of omega-3 fatty acids. Omega-3 fatty acids are beneficial because they provide fluidity to cell membranes and improve communication between brain cells. Omega-3s also reduce the clotting ability of platelets, thus potentially decreasing the incidence of heart attacks and strokes. Two very important omega-3 fatty acids are eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) which together are found in fish oils. These fatty acids are found in seafood, especially mackerel, salmon, striped bass, rainbow trout, halibut, tuna, and sardines.

Pharmaceutical grade fish oils
Many companies claim that their fish oil supplements are pharmaceutical grade fish oil. However, we are not aware of a grading system for fish oils that involve the pharmaceutical grade label. Most herbs and supplements are not graded in this manner. Certain amino acids, such as tryptophan, may be graded as pharmaceutical grade, but we are not aware of such labeling for fish oils.

Side effect, safety, concerns, danger, risk
Besides bad breath, there is a possibility that high doses of fish oils could lead to side effects such as thinning the blood and causing bleeding. It's also possible that high doses of fish oils could interfere with the optimal functioning of natural killer cells, white blood cells, or other cells in the immune system. It is probably best not to take more than 3 fish oil capsules a day for prolonged periods, except for the treatment of a medical condition, until we determine how fish oil supplements influence the immune system.
   It is possible that fish oil side effects of blood thinning could accentuate the blood thinning properties of Coumadin and aspirin. Taking fish oil capsules can thin the blood even more when taken along with warfarin ( Coumadin ).

Omega 3 Fish oil for dog
Dogs and cats may also benefit from fish oils if their diet does not have enough alpha linolenic acid or other sources of omega 3 fatty acids.

Fish oils and antioxidants
Q. I had read an article where it stated that individuals who take a lot of antioxidant supplements are in fact reducing the effectiveness of fish oil and its cancer-fighting abilities.
   A. We have not come across any long term human studies regarding this issue. Cancer takes years and decades to develop. We don't see how the statement regarding antioxidants and fish oils can be made without such research being done.

Allergy
Can someone allergic to shellfish take fish oil supplements?
    Omega 3 fish oil supplements are obtained from the meat of fish such as mackerel, herring, tuna, salmon, cod liver and halibut, not from shellfish. We have no reason to believe those with shellfish allergy would have problems taking fish oil supplements. However, your doctor is the final decision maker as to the appropriateness of taking fish oil supplements in your particular condition. If someone is allergic to certain fish, such as the ones mentioned above, then they need to contact the manufacturer to find out the fish source of the fish oil supplements.

Almost every vitamin company sells fish oils. Some of the major players are Carlson, Nordic Naturals. Carlson fish oils are advertised in many health magazines. Nordic Naturals carries a wide list of different types of fish oil supplements, including those for children.

Questions
Q. Does fish oil itself have any vitamins?
   A. Fish oils do not have any significant amount of vitamins. However, fish liver oils have vitamins A and D.

Is it possible for the body to develop a tolerance to fish oil supplements? I have been taking them for about four months now (one in the morning and one in the evening). At first, the benefits that I noticed were that I was less stressed, less nervous, and generally in a better mood.
    This is difficult to answer. We have not had such reports regarding fish oil tolerance. One option is to take a couple of weeks off and then resume to see what happens.

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