One capsule of omega-3 for a healthy happy heart?

Another juicy head line this week. This time it’s the Daily Express reporting the findings of a study led by Dr Carl Lavie and published in the Journal of the American College of Cardiology. The outcome of the study suggests that eating oily fish can help ensure a long life, as it slashes the risk of heart failure by a third and as a result of these findings there is a push for everyone in Britain to be taking omega-3 (about time too). So we are told that people with existing heart problems should take at least 800 to 1,000mg of omega 3 each day – the amount found in three to four 3oz portions of oily fish a week. The news story then goes on to quote that half that amount of fish would provide enough omega-3 for healthy people – so 400-500mg, “the equivalent of one supplement capsule”.

So I can now hear the thunder of feet rushing down to Holland and Barrett a bid to snap up their EPA 1000mg fish oil capsules. This has to be good value for money surely? Firstly, they come in a tub so big that it nearly take up the whole basket leaving very little space for your ginseng and dried apricots (but you do get change from a tenner). Secondly, the pot clearly states “EPA 1000mg” so it’s all good – isn’t it? Well no! This is where the public get misled and some what confused (and I get annoyed). My first point that I feel needs clarification is the statement – “equivalent of one supplement capsule.” This is confusing and misleading. Firstly capsules mostly come in two sizes, 500mg and 1000mg (like our H&B example above). Secondly there is a huge variation in the quality of supplements. Generic fish oil (including Mr Holland and Mr Barrett’s “EPA 1000mg”) is simply oil that has been extracted from the flesh of fish and filtered but not molecularly distilled or concentrated. These types of supplements are cheap and tend to be easy to spot on the shelves, generally containing 180mg EPA and 120mg DHA per 1000mg of fish oil. Indeed, a far cry from the boastings of “EPA 1000mg” (which actually refers to the size of the capsule and not the EPA content!).

In order to achieve anything close to the 400-500mg of omega-3 through consuming just one supplement capsule, then we need to be looking at pharmaceutical grade products. These oils undergo rigorous molecular distillation and can achieve as much as a 70% concentrated blend of active ingredients (namely EPA and/or DHA). Molecular distillation not only concentrates these fatty acids but also ensures that the oil is free from contamination and from vitamin A. Because of the processes involved and the amount of active ingredients in each capsule, the price goes up, but then you are paying for a quality product. Even then, a 70% oil falls short of achieving the concept of ‘one capsule is enough’. Not all supplements are the same and cheaper products will not give the benefits that the article suggests. EPA and DHA compete for the sn-2 site of phospholipids, and therefore the ratio of EPA to DHA within any supplement becomes important in influencing which fatty acid is the most active in any preparation. My second point…

This goes back to my “black or white” theory. Fatty acid metabolism and the role that these fats play in cardiovascular health is intensely complicated and it is no wonder that the public can find tabloid information confusing. EPA and DHA have very different mechanisms of action and therefore to generalise the effects of ‘omega-3’ as a whole is over-simplifying the issue. Indeed, many studies are now taking DHA and placing it gently to one side in order to focus on the activities of EPA. Whilst yesterday’s news is interesting it’s far, in fact, from novel, which is partly why I roll my eyes. In regards to taking an EPA-only product, a good line of support for the role of EPA in cardiovascular health for this comes from the Japan Eicosapentaenoic acid (EPA) Lipid Intervention Study (JELIS trial) which was the first large-scale, prospective, randomized trial of a combined treatment with a statin and EPA for the prevention of major coronary events. These studies take highly purified preparations in doses of around 2g daily to obtain the results that are subsequently published in major journals. This information, it seems to me, is then portrayed to the public via a game of Chinese whispers, with the resulting message being generally down played. The article furthers exemplifies my point that there is a general need for the public to be aware of the variation in the quality and dosage of omega-3 supplements.