Thursday, November 5, 2009

Everything You Wanted To Know About Fish Oil. Ever.


Fish Oil. Is it just for the old man with a heart problem? No way.

Omega-3 fatty acids and athletics
Simopoulos AP.

The Center for Genetics, Nutrition and Health, Washington, DC 20009, USA.

Human beings evolved consuming a diet that contained about equal amounts of y-6 and y-3 essential fatty acids. Today, in Western diets, the ratio of y-6 to y-3 fatty acids ranges from approximately 10:1 to 20:1 instead of the traditional range of 1:1 to 2:1. Studies indicate that a high intake of y-6 fatty acids shifts the physiologic state to one that is prothrombotic and proaggregatory, characterized by increases in blood viscosity, vasospasm, and vasoconstriction, and decreases in bleeding time. y-3 fatty acids, however, have anti-inflammatory, antithrombotic, antiarrhythmic, hypolipidemic, and vasodilatory properties. Excessive radical formation and trauma during high-intensity exercise leads to an inflammatory state that is made worse by the increased amount of y-6 fatty acids in Western diets, although this can be counteracted by eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). For the majority of athletes, especially those at the leisure level, general guidelines should include EPA and DHA of about 1 to 2 g/d at a ratio of EPA to DHA of 2:1.

PMID: 17617998 [PubMed - indexed for MEDLINE]

So now that you want to take fish oil, you need some questions answered about omega 3's, essential fatty see these terms day in and day out in the news, on TV, on internet forums. So what's the big deal? Why should the aspiring athlete supplement with fish oil? Here's a breakdown on everything you need to know about it.

Omega Three Fatty Acids

Omega-3 fatty acids (sometimes seen as n-3, ω-3, or O3) are from the family of polyunsaturated fatty acids (PUFA); both omega-3 and omega-6 are considered essential fatty acids (EFA), meaning humans must obtain them from diet.

ω-3s can be further broken down into 7 separate fatty acids; ALA (Alpha Linolenic Acid), EPA (Eicosapentaenoic Acid) and DHA (Docosahexaenoic Acid) will be discussed here in the context of fish oil supplementation.

ω-3s act as generalized anti-inflammatory agents in the body; their balancing (or unbalancing, as it is today) counterparts are the eicosanoids of the ω-6 family of PUFAs, which are involved in the inflammatory processes of the body. The issue in today's society is the ratio of ω-3 to ω-6 intake; by many accounts, this ratio is anywhere from 20:1 to 50:1 in favor of ω-6. In Paleolithic times, it was more along the lines of 2:1 or 3:1. This ratio, and the balance of, is essential to understanding why one should supplement with fish oil. It is also essential to note that ω-6, while being "pro-inflammatory", are also essential to bodily functions like clotting factors and immune response. As stated before, it is the ratio that is the issue.

Dietary sources ω-6 are found in whole grains, eggs yolks, meats and nuts; the majority of the ω-6 that is over consumed by North Americans comes in the form of linoleic acid (LA), found in corn, sunflower, safflower and soybean oil.

Dietary sources of ω-3 are found in fish, seed (flax), and nut (walnut) oils. In botanical dietary sources, EPA and DHA are not found (with the exception of microalgae); the ω-3 ALA is. While this is a beneficial EFA, the conversion to EPA and DHA in the body is extremely low, at rates of 2-15% and 2-5%, respectively. For those following a strict vegan diet, botanical sources of ALA may be the only rudimentary source of EPA and DHA.

Why Fish Oil?

Fish oil, specifically fatty cold water fish like mackerel, tuna, and salmon, contain high levels of omega-3 fatty acids from eating smaller prey fish like herring and sardines; likewise, sardines and herring contain O3's from feeding off of microalgae that produce it. No other food source on the planet contains levels of EPA and DHA as high as are found in cold-water fish. Krill oil also contains high levels of EPA and DHA ( they feed on phytoplankton, much the same as herring and sardines); at this time, though, krill oil supplementation producers are limited and not as cost-effective or available as fish oil. As it becomes more popular, prices may drop.

Why Not Just Take ALA?

As far as supplementing with ALA in the form of flax or other vegetable-based oils, unless one has a moral dilemma to consuming fish, it ultimately is a highly ineffective way of getting therapeutic amounts of EPA and DHA. To take from Dr. Eade's book, The Protein Power Lifeplan:

"Some people refuse to take (fish oil) because they can't stand the taste or they are vegans and refuse to eat food of animal origin. For these folks, flax seed oil is great. It gives them a great source of omega-3 fats that they otherwise wouldn't get. But taking flax seed oil is like buying crude oil and running it through your home distillery to make gasoline for your car. If that's the only way you can get gasoline, then that's what you have to do. if you can buy the gasoline already distilled, though, it's much more efficient to do that.

Lyle McDonald cites a recent study on ALA conversion, and also makes some excellent comments here.

Another option for vegans are algae/spirulina based EFA supplements that contain both EPA and DHA.

What Kind of Fish Oil Should I Take?

There's lots of choices out there on the shelves, just like with any supplement. Which one should a guy (or gal) take, and which brands should one avoid? The answer is easier than you think; it's all in the label. Look for three things:
  • Molecular Distillation
  • Types of fish listed
  • EPA and DHA content per capsule

Molecular distillation is essential; this can't be overstated. If it's not listed as such, the purity of the fish oil is questionable, and you may be doing yourself more harm than good. Molecular distillation (also called vacuum distillation) is used to separate oil from impurities like accumulated heavy metals at the cellular level. Centrifugal is the most common and effect method at the present time. Keep in mind Steam distillation, while sounding "cleaner", does not in fact, do a superior job. It also involved using extremely high heat for prolonged periods, effectively altering the structure of the fish oil.

A very high quality brand of fish oil found in many on-the-shelf products is Meg-3; this can be compared to Creapure, an ultra-high quality creatine monohydrate found in reputable brands.

Also look for the types of fish used; because so many companies are jumping on the fish oil bandwagon, the quality of products in general is likely to go down. As stated before, look for cold water fish, and preferably, smaller fish with shorter lifespans, like sardine and herring.

The EPA and DHA content are self-explanatory; the most common strength is 180mg EPA and 120mg DHA (written as 180/120). Concentrated forms are available in the 400/200 dose.

Another option is liquid fish oil; one clear advantage is that the quality of the oil will be readily apparent. One drawback from capsules is that you may not know if they have become rancid, which is an important concern that will be addressed farther down the page.

Cod Liver Oil - If you're looking to get a decent amount EFAs, this is NOT a good option; cod liver oil contains vitamin A and D, and to get a therapeutic amount of EPA/DHA, you'd seriously overdose on the fat-soluble vitamin A. Some versions of cod liver oil now on the market HAVE decent amounts of EPA and DHA, but here's something to chew on:

"Although activated vitamin D and vitamin A signal through common cofactors, they compete for each other's function. Retinoic acid antagonizes the action of vitamin D and its active metabolite. In humans, even the vitamin A in a single serving of liver impairs vitamin D's rapid intestinal calcium response. In a dietary intake study, Oh et al found that a high retinol intake completely thwarted vitamin D s otherwise protective effect on distal colorectal adenoma, and they found a clear relationship between vitamin D and vitamin A intakes, as the women in the highest quintile of vitamin D intake also ingested around 10,000 IU/d of retinol.

In other words, don't take cod liver oil for it's EPA and DHA, don't take it for it's vitamin D (because essentially it's useless), and don't take it for vitamin A, because you should be eating more goddamn vegetables for that.

Are There Dangers With Fish Oil?

Generally speaking, no. But there are a few concerns people need to be aware of. One is possible rancidity of fish oil, and the side effect of blood thinning.

Rancidity: - While the benefits of fish oil can't be refuted, on the flip side is spoiled, or rancid fish oil. Being a highly unsaturated fat, fish oil is extremely vulnerable to oxidation; this is the reason the fish in your fridge is only good for a few days, max. Free radicals LOVE unsaturated fatty acids, just like your 18 year old cousin from San Diego LOVES going across the border to Tijuana to get hammered. It's not a good thing, and it's kinda scary.

When fish oil become rancid, it becomes a lipid peroxide; this turns a potentially helpful supplement into a harmful one. That last thing we need to do as athletes is add to our free radical load, especially with peroxides. So how does one avoid this? A number of ways:
  • Make sure the fish oil capsules you buy are of quality, and properly foil-sealed when you first open it.
  • Make sure the liquid fish oil you buy is in an opaque GLASS bottle and properly sealed when you first open it.
  • Put your fish oil in the fridge; with capsules, another option is to place them in the freezer. This will prolong the shelf life, as well as prevent oxidation.
  • Bite into your fish oil capsules. Yes, I mean it. This is to tell you exactly how fresh your capsules are, and if they are rancid, you will know it right away. Fresh fish oil will be clear, particulate-free, and tastes mildly fishy, as one would expect. Rancid fish oil tastes like licking the bottom of a garbage dumpster in central New York. Biting into capsules is recommended by the highly respected Dr Michael Eades, author of Protein Power.

    There's also been some studies done regarding fish oil intake and vitamin E; because of the potential for fish oil to oxidize, even in the blood, some have suggested that vitamin E be ingested along with fish oil. Other studies have shown a synergistic (enhanced) effect, and even others have shown a decrease in blood levels of vitamin E. Many manufacturers will combined fish oil and vitamin E to act as a preservative, so this may be a completely moot point.

    Excessive Bleeding - Fish oil directly affects the blood platelets in a similar manner to acetylsalicyclic acid (Aspirin); it causes platelet aggregation inhibition, or in layman's terms, causes the blood to become "less sticky". It's not a blood thinner per se, but more like a blood slicker.

    So is this an issue with athletes, specifically ones involved in contact sports? Probably not. To date, there's been no record of problems with excessive contusions, intracranial hemorrhage, or uncontrolled bleeding from taking fish oil. If you are dosing in a resonable manner, this shouldn't be an issue.  That said, if you are already taking something like Aspirin (acetylsalicylic acid) or Coumadin (warfarin), then I'dcautious adding fish oil to the mix. The Combined Effects of N3 fatty acids & Aspirin

    Studies aside, if you experience excess bruising or bleeding, use common sense, and LOWER your dose.

    Raising LDL - Taking a quality fish oil supplement CAN cause a potential rise in your LDL level, but one must understand why before one freaks out like a 12 year old girl at a canceled Lady Gaga concert.

    In regards to fish oil intake and raising LDL, the actual method of calculating LDL is at fault, and varying levels of HDL, shifts in IDL and VLDL to LDL, and triglycerides all play a factor. The current and commonly used method of calculating LDL is just that---a calculation, not a specific measurement. Furthermore, it only calculates overall LDL, and not a specific type---there are 7 different subclasses of LDL, with VLDL being one of the few that's actually harmful. If your physician doesn't know this, and recommends you stop taking fish oil based on your LDL level, I would highly suggest a second opinion from a more knowledgeable physician.

    "Fish oil is a very effective method to clear IDL and VLDL, though sometimes it also causes a shift of some IDL and VLDL into the LDL class. Thus, the apparent increase in LDL."

    - Dr William Davis, Cardiologist

    Fish Oil Cloudy?

    Some fish oils become cloudy when cold because they contain monounsaturated and saturated fatty acids---which are naturally occurring in whole fish, and still extremely essential and healthy. Keep in mind all the healthy benefits of cold water fish were done using subjects that consumed WHOLE fish, not fish oil.

    Depending on how highly processed your fish oil is, this may or may not occur. If one is concerned, the "Bite" test is required---bite into a capsule. I've seen this in every single bottled liquid fish oil I've used, and none had been rancid.

    How Much Should I Take?

    There's a lot of variation in opinion on this; some recommend low doses in the range of 900mg EPA/DHA, others opt for extremely high doses of over 10g; Tolson recommends between 1-4g, and Berardi between 3-6g.

    For athletes, little data is available. Dr. Barry Sears and Robb Wolf both used to recommend a high-end dose of 0.5-1.0g/10lbs BW; this equates to 8.5g/day for a 170lb athlete. "Maintenance" dosing has been recently been thought to be more prudent, at 0.25g/10lbs BW.  Anecdotal reports of decreased DOMS, decreased recovery time, and accelerated BF loss are abound, but no well controlled studies exist.

      The most common dose, Wolf and Sears aside, is approximately 3g daily; this would translate into 10 capsules of 180/120 strength. So at 300mg of combined EPA and DHA (get it? 180mg EPA and 120mg DHA would equal 300mg combined EPA/DHA) per capsule, you'd have to take 10 a day. Break 'em up into 2 caps 5 times a day, or 3 caps morning/noon, 2 caps supper/bed, or whatever. I'm sure you're smart enough to figure that part out.

    When starting out, it would be prudent to "ramp up" your dose; start at 1 capsule 3x a day for a week, then 2 caps 3x a day for a week, etc, etc.  Give your body time to adapt to the fat intake, and (potentially) offset any coagulation issues.

     When Should I Take My Fish Oil?

    Based on this study, I'd say take it with meals for better absorption:

    Absorption of eicosapentaenoic acid and docosahexaenoic acid from fish oil triacylglycerols or fish oil ethyl esters co-ingested with a high-fat meal

    Lawson LD, Hughes BG. Murdock Pharmaceuticals, Springville, Utah 84663.

    The absorption of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) from fish oil triacylglycerols and fish oil ethyl esters consumed in a high-fat meal (44 g total fat) by male volunteers was measured and compared to values previously reported for consumption in a low-fat meal (8 g total fat). Absorption of EPA, but not of DHA, from fish oil triacylglycerols was significantly improved from 69% to 90% by co-ingestion with the high-fat meal. Absorption of both EPA and DHA from fish oil ethyl esters was increased three-fold, to about 60%, by co-ingestion with the high-fat meal, indicating that absorption of fatty acid ethyl esters is highly dependent on the amount of co-ingested fat.

    Personally, I take 3g x 3 a day (5 capsules of the Costco brand pictured), morning, later afternoon, and night, for a total of 9g of combined EPA and DHA.  This puts me at little over 0.5gEPA/DHA per 10lbs BW.

    Related Links and Articles

    Fish Oil Supplement Profile - David Tolson. Explanations on how fish oil works in body comp, cardiovascular disease, depression, and recommended dosages.

    Fishy Advice, Part 1 - Eric Cressey. Cites studies and stats on the benefits of fish oil in specific diseases.

    Fishy Advice, Part 2 - Eric Cressey. Continuation of above.

    Dr. Barry Sears on Fish Oil and Athletes - Interesting look at pro athletes and a combo of fish oil/GLA. Well worth the read.

    PUFA Intake In Humans - From Stephan at Whole Health Source. Great article.

    Oil Of Pisces - Website that reports on fish oil and specific disease processes.

    American Heart Association on Fish Oil - PDF article. 

    Essential Fatty Acids - Normally, Wikipedia is a risky source of info, but this link gives a good layout of EFAs, with links to omega-3 and omega-6 listings.

    American Journal Of Clinical Nutrition Study on Fish Oil and Exercise, full PDF - Well controlled study on the effects of fish oil and exercise.

    Dr. Briffa on Omega-3 to Omega-6 Ratios and Body Comp Effect - Dr. John Briffa takes a look at O3 to O6 ratios and how this can affect body comp and cardiovascular health.

    International Fish Oil Standards - IFOS tests supplemental fish oil to exceptionally high standards. Click on "consumer report" to take a read.

    Alan Aragon On Fish Oil  - Alan Aragon does a thourough breakdown on fish oil; great read.