The Mythologies of Fish Oil

Here are some of the marketing statements about fish oil products that that are simply not true.

Products that contain EPA only are more effective for inflammation than containing both EPA and DHA.

The real power of omega-3 fatty acids is to increase the resolution of inflammation.  This is only accomplished when EPA and DHA are metabolized into specific hormones known as resolvins.  The resolvins from EPA and DHA have different activities and different receptors.  Therefore you need both EPA and DHA in the blood and the tissues to resolve inflammation.  EPA is more important than DHA in reducing the initiation of inflammation because is it a competitive inhibitor of the enzymes (cyclooxygenase and thromboxane synthase) due to it’s three-dimensional structure being virtually identical to arachidonic acid (AA).  DHA cannot act as a competitive inhibitor to these enzymes that are important in making pro-inflammatory eicosanoids, which initiate inflammation.  This is why the AA/EPA ratio is routinely used in research studies to determine the extent of inflammation.

EPA is the dangerous component that increases the risk of bleeding.

The largest cardiovascular study in history (JELIS) with more than 18,000 patients all taking statins where supplemented with high-dose EPA for 3 ½ years. At the end of that time period, the subjects getting the EPA and statins had 20% fewer cardiovascular events that those taking statins and olive oil as a control.  Subsequent analysis of those patients indicated that only the lowering of the AA/EPA ratio was correlated with improved cardiovascular function.

EPA is not being recommended for pregnant women and old people.

EPA is critical for both groups of individuals.  Both EPA and DHA enter the brains at equal rates.  The DHA is stored in the synaptic membranes for increased flexibility and the EPA is converted to resolvins to reduce neuroinflammation.  This is critical for the fetus, the mother, and the elderly to maintain appropriate neurological function.  This also why there is no correlation of increasing DHA in treating depression, however the correlation with increased EPA is very robust.

DHA does a perfect retro-conversion to EPA.

This is not true.  Only about 10% of the DHA can be reconverted back to EPA.  On the other hand, EPA is readily metabolized into DHA.  Without adequate EPA levels, it is impossible reduce the initiation of inflammation or increase the rate of resolution of inflammation.

People over 50 years old can’t convert EPA to DHA.

This is also untrue.  The conversation of EPA to DHA is normally slow, but there is no indication that it slows down with the aging process.

Krill oil is an omega-3 product is the phospholipid form that is similar to our cellular membrane. For this reason the absorption is better and provides a better response.

Krill oil is not fish oil.  It is extracted from small shrimp first by hexane (i.e. gasoline) and then precipitated by the addition of acetone (i.e. nail polish remover).  The resulting product is a combination of free fatty acids, monoglycerides, and maybe 20% phospholipids.  These products can’t be refined to remove contaminants such as PCBs. Krill oil is also very low in EPA and DHA compared to fish oil and especially compared to refined omega-3 fatty acid concentrates

Omega-3 fatty acids in the reconstituted triglyceride format are more “natural” than omega-3 fatty acids in the ethyl ester format.

This is also not true.  The reconstituted triglyceride has a completely unnatural configuration of omega-3 fatty acids compared to that found in natural fish oils.   

What is the correct ratio of EPA to DHA that will provide maximum health benefits?

What is important is not the ratio of EPA and DHA in a supplement, but the ratio of AA/EPA in the blood.  The AA/EPA ratio provides insight into the potential balance of the initiation of inflammation and its eventual resolution.  The ideal AA/EPA ratio is between 1.5 and 3 as found in the Japanese population.  For comparison, the AA/EPA ratio in the American population is 18.  The higher the AA/EPA ratio, the less likely you are to have sufficient ability to resolve inflammation therefore creating chronic low-level inflammation that is the underlying cause of virtually all chronic disease.  DHA levels will always be higher than EPA levels in the blood because of the continuing metabolism of EPA into DHA. I have found that using a 2:1 ratio of EPA and DHA provides the best clinical benefits as it ensures there will be adequate levels of both EPA and DHA.  You need them both because they have different functions.