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Recently omega-3 fish oil made headlines worldwide as scientists found it is more potent than statins like Lipitor or Zocor in reducing heart death, and that it may protect against Alzheimer's and reduce the need for medication for people with joint pain. This joins the many studies showing that omega-3 fish oil can boost children's IQ and focus, increase adult fertility, mitigate mood disorders, protect the aging retina, ease skin illnesses and reduce sunburns, thereby likely providing at least some protection against skin cancer.

With several decades and over 25,000 studies backing the benefits of omega-3s, it's recommended by the American Heart Association, the Arthritis Foundation, the World Health Organization, and the US Department of Health, among others.

What is omega-3?

Omega-3 is not just one substance but a family of several. Most common is ALA (alpha-linolenic acid), found in nuts, vegetables or flaxseed. The downside to ALA is that the body must take this basic alpha-linolenic acid and convert it to eicosapentanoic acid (EPA), nature's best inflammation fighter, and then to docosahexaenoic acid (DHA), which is important for the correct architecture of cell membranes. Studies have shown that only 3% to 5% of ALA ingested is successfully converted to EPA and DHA; some people are disposed genetically or by serious illness or stress to be even less successful in this process. (Thus, if any of your patients insist on omega ALA substances such as flaxseed oil, you'll need to recommend that they ingest one to two cups a day to get a potentially proper dose of converted EPA and DHA.) The more potent and direct route is to ingest EPA and DHA directly, and these omega-3s are found only in fish and breast milk. Thus, everyone except nursing babies must get their omega-3 EPA/DHA from fish, either naturally eaten or taken as a liquid or capsule supplement.

How does omega-3 EPA/DHA work so well?

Most simply, it enhances the elasticity of the cell membrane, allowing cells to de-toxify and absorb nutrients more effectively. This elemental function allows all mammalian systems, nervous, skeletal, digestive, etc, to function at peak efficiency. In addition, omega-3 EPA/DHA is a strong inflammation fighter, counter-balancing the opposing effects of omega-6. While our ancestors probably ate nearly equal amounts of omega-3 and omega-6 fats, most Westerners today consume 15 to 30 times more of the pro-inflammatory omega-6s from vegetable oils and processed food than they do the healthy omega-3s from sources like fish and nuts. 1 Since it's difficult for most people to reduce their omega-6 consumption, the omega-3 to -6 balance can most efficiently be restored by increasing the omega-3 intake. Chronic inflammation is now considered a main culprit of most chronic and debilitating diseases such as heart disease, Alzheimer's, arthritis and macular degeneration.

What is the comparative effectiveness of fish in the diet versus liquid or capsule supplements?

Your patient would have to be an ardent fish-lover to get the required omega-3 EPA/DHA in their natural diet, on the order of eating a large fillet of salmon, sardine or anchovy many days a week, along the way ingesting the heavy metals and toxins found in today's fresh fish. Salmon, 6 oz may give 1.5-2g of EPA/DHA Cod, 6 oz may only give 0.3g Supplementation is the safe and easy answer. The EPA/DHA content in three supplement categories follow: Regular fish oil capsules contain up to 0.3 gram. High-concentrate fish oil capsules contain up to 0.6 gram. Fish oil liquid teaspoons contain up to 1.2 grams.

What dosage should I recommend?

Most double blind studies have used 2 to 5 grams of omega-3 EPA/DHA per day. The typical dose to change blood parameters starts at 2 grams (8 regular capsules or 2 teaspoons of liquid). Arthritis (reducing pain and morning stiffness) clinical studies typically use 3 grams or more (10 -12 capsules or 3 teaspoons). Eczema/psoriasis: same as above. Depression, Alzheimer's, ADD, autism: same as above or slightly weight adjusted. Heart prophylaxis, statin adjuvant, stroke, diabetes: 2 grams or more Supplementation during pregnancy to boost child IQ: 2.4 grams2. Thus, the commonly recommended daily dose listed on capsule packaging of 1 or 2 capsules for an adult appears to be too low and is not based on any clinical research study. An adequate dose is required to obtain adequate health protection.

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