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Research shows that consuming a regular dose of fish oil can lower your risk of heart disease, reduce inflammation, and prevent Alzheimer's disease. (Shane-McWhorter, 2018). Fish oil is rich in omega-3 fatty acids, which are essential for your body to build healthy cell membranes. These fatty acids also aid in brain development and support healthy skin and hair. How do you know if you are getting enough in your diet, and should you consider supplementation? There are so many different options out there, and choosing the best one can be confusing.

How much fish should you eat, and what kind?
The American Heart Association recommends people eat at least two servings of fish per week for a total of 6-8 ounces. Keep in mind, a typical serving of fish is about 4 oz., or the size of a deck of cards.

Cold-water, oily fish,(as opposed to white fish) are best. These are all great sources of omega-3 fatty acids:
- mackerel
- lake trout
- herring
- sardines
- albacore tuna
- salmon

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What if I don't like fish?
That's ok. I'm still working on it too. While eating high quality fish is the best way to get your fish oil, it's easier said than done for many people. The typical Western diet is low in fish oil. I definitely don't eat enough fish on a regular basis. I'm just not great with shopping for and cooking fish at the moment, and it's not my number one priority. Realistically it's not going to happen for awhile. That's why it's a good idea to take a fish oil supplement to ensure you are getting those essential omega-3's. Essential means that your body can't make it on its own, so it needs to come from outside sources.

What if you're a vegetarian? 

While flaxseed  and walnuts are also natural sources of omega-3's, your body can't process the fatty acids from these as readily as fish oil. If you decide to take flaxseed supplement, you'll need to take a higher dose for the same benefits. (Harvard Health Publishing, 2019).

How much should I supplement?
Look for a supplement that provides 1000-4000 mg  per day of combined EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). (Rakel, 2018).

EPA DHA say what?
EPA and DHA are two specific fatty acids that are only found in animal sources. You need both of them, but they each have slightly different functions. DHA is best for brain health and development, while EPA helps reduce inflammation. Choosing the right ratio of EPA to DHA is a little more complicated than you might think. The right amount for you depends on a number of factors including your diet and health goals. In short, think DHA for brain stuff, and EPA for inflammatory processes like high blood pressure or psoriasis. (Nutrition Notes, 2019). When shopping for a fish oil, be sure to check the label to see how many milligrams of both DHA and EPA it contains. If your main priority is brain health, look for a 2:1 ratio of DHA to EPA with at least 50% DHA. (Rakel, 2018).

I heard fish was contaminated with heavy metals and mercury, though.
That's true, but if you proceed with caution and choose high-quality fish, the benefits outweigh any potential risks. Some fish may contain high levels of mercury, polychlorinated biphenyls (PCB's), dioxins, and other environmental contaminants. You want to avoid farmed salmon which contains high concentrations of PCB's. Instead look for wild caught salmon. Be sure to trim the fat and avoid over-cooking to reduce exposure. Also try to avoid sharks, swordfish, tilefish, and king mackerel as they contain the highest levels of mercury. (Rakel, 2018). Check out Monterey Bay Aquarium's Seafood Watch program for tips on choosing the best sustainable seafood options in your state.

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What does the research say?
Fish oil supplementation is more than just wishful thinking. It has the science to back it up. Quality research has shown numerous benefits of regularly consuming fish oil:

It can help prevent cardiovascular disease
It is one of the most effective treatments for elevated triglycerides, and has been shown to reduce triglyceride levels by 50% in some patients. (Rakel, 2018).

It's also good for inflammatory conditions like psoriasis
Rates of psoriasis and other inflammatory conditions are low in populations that consume high levels of fish oils. It works by inhibiting inflammatory cytokines, and can improve chronic plaque psoriasis. (Rakel, 2018).

It's also good for brain health and may help prevent Alzheimer's disease
Most data clearly shows that increased fish intake lowers the risk for Alzheimer's disease development. It's also associated with lower levels of the amyloid beta plaque in the blood that is related to Alzheimer's. (Rakel, 2018).

The bottom line
If you're eating less than 2 servings of high-quality, sustainably-sourced fish each week, it's a good idea to supplement with a fish oil.
Go for a dosage of 1000-4000mg of combined EPA and DHA per day. Look for wild-caught salmon to avoid mercury exposure.

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References

Nutrition Notes Team, (2019, February 08). Optimizing the EPA:DHA ratio. Retrieved July 28, 2020, from https://blog.designsforhealth.com/node/948

Harvard Health Publishing (Ed.). (2019, July 29). Why not flaxseed oil? Retrieved July 28, 2020, from https://www.health.harvard.edu/heart-health/why-not-flaxseed-oil

Rakel, D. (2018). Integrative medicine. Philadelphia, PA: Elsevier.

Shane-McWhorter, L., (Ed.). (Oct 2018). Fish Oil - Special Subjects. Retrieved July 28, 2020, from https://www.merckmanuals.com/professional/special-subjects/dietary-supplements/fish-oil

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