Family practice physician and Chairman of ALP Life Sciences Robert A. Barker, MD, with assistance from his team of researchers, answer your questions and post answers. When appropriate, a link to peer reviewed scientific research is included in the answer when posted.
Are there different forms of fish oil, and what is the difference between them?
The short answer is yes. Fish oil is available in three forms, i.e. the biochemical form that the EPA and DHA omega 3 fatty acids are in when you buy them in capsule or liquid form. These three forms are as follows; 1) ethyl ester (EE), 2) triglyceride (TG), and 3) free fatty acid (FFA). There is a big difference in these types of fish oil and how your body recognizes, digests and absorbs them.
The most common form of fish oil on the market is the ethyl ester (EE) alcohol based form, which is a synthetic manmade form and has an alcohol metabolite “ethyl ester” backbone. The main reason most fish oil is in the EE form is that this alcohol form is easier and cheaper to produce compared to the natural form. The natural form of fish oil is triglyceride (TG), which has a glycerin backbone to which the EPA and DHA fatty acids are attached, and is how EPA and DHA come in wild fish. If the bottle doesn’t say triglyceride (TG) or re-esterified triglyceride (rTG) then it is not likely triglyceride (TG). Companies that invest in the expensive steps required to produce a triglyceride (TG) form will always put it on the label. The triglyceride (TG) form is the main way your body transports and uses fats to help make every cell in your body. The triglyceride (TG) form increases your body’s natural absorption of the important EPA and DHA omega 3 fatty acids through the lymphatic system, while the ethyl ester (EE) form is mostly absorbed through the liver via the portal vein, which is not the natural pathway of Omega 3 absorption. Free fatty acid (FFA) form is the less common form where the glycerin backbone has been removed leaving the EPA and DHA unattached to the natural glycerin backbone. The availability of the free fatty acid (FFA) form of fish oil is limited, but research points to its absorption being similar to triglyceride (TG). The main take away from these different forms is found in this study: Bioavailability of fish oil forms
Many studies have been done on fish oil absorption. There are a few that say triglyceride (TG) and ethyl ester (EE) are amount the same, but most studies indicate that triglyceride (TG) delivers 20-60% better absorption. No studies have concluded that ethyl ester (EE) is better absorbed than the triglyceride (TG) form of fish oil. For the best value you need to take the triglyceride (TG) form of fish oil, and taking it with other fat increases absorption. The form of fish oil makes a big difference in how it is absorbed and used by the body, but more on absorption in a future “Ask the Doctor” response from ALP Life Sciences.
Do starches and carbs in the diet have a positive or negative effect on the production of these beneficial omega-3 fatty acids?
Normally a negative effect – high glucose (sugar) levels from starches and carbohydrates cause the body to increase its natural production of insulin, which in turn converts DGLA, an omega 6 fatty acid, to arachidonic acid (AA), which is the main culprit in prolonging the pro-inflammatory cause of accelerated chronic disease.
I take a “statin” drug to reduce my cholesterol level – any problems there?
Actually, yes – statins are important in lowering cholesterol, and you should take them as your doctor recommends, but statins have been shown to increase arachidonic acid production, a known causative factor in chronic disease.
I seem to be reading more and more about inflammation these days, and its role in various disease states – what’s the current state-of-the-art?
Medical science is learning more every day about this process of inflammation, and perhaps we can simplify it. We now know that there are two types of inflammation, known as pro-inflammatory response, and anti-inflammatory response. When damage occurs in the body, our first immune response is pro-inflammatory – its function is cell destruction. It simply clears away damaged cells so that the body can rebuild. This response is then followed by the anti-inflammatory response – its function is one of cell rejuvenation. It rebuilds and replaces damaged cells, and might be best understood as “the healing process.” What we understand as wellness can be described as a proper balance between these two functions. Problem: an unbalanced diet, one high in “negative” fatty acids, strongly supports the pro-inflammatory response, which becomes harmful when it a) continues the cell destruction phase when no longer needed, and b) continues to negatively impact the cell rejuvenation phase. The result is an increase in chronic inflammatory diseases over time. Such conditions as arthritis, asthma, cancer, type II diabetes, Crohn’s disease, heart disease, and others have been linked to this uncontrolled, ongoing pro-inflammatory response.
How can I tell if taking ALP High 3 is providing any benefit?
Wouldn’t we like to know that about everything we take? Fortunately, there is a simple way to do that. The Omega Score whole blood test, which includes the AA/EPA ratio test, is the appropriate measure of the ratio of pro–versus anti-inflammatory processes underway in the body, based on diet and omega 3 (the “good” omegas) versus omega 6 (the bad omegas) consumption, and these results have been directly linked to life expectancy factors. By using this simple “finger stick” blood test, both physician and patient can literally watch the good anti-inflammatory process taking place. This test focuses not only on the amount of omega 3s and other omegas, but most importantly on the balance between omega 3s (the EPA part) and omega 6s (the AA part) as well. Here are some specific examples:
– Increasing the omega-3 whole blood score from 6.1% to 10.2% has been linked to an 80% lower risk of sudden cardiovascular death;
– An omega 3 serum equivalence equal to or greater than 7.2 has been linked to a 32% reduction in heart disease;
– An EPA/DHA serum equivalence equal to or greater than 4.6 has been linked to a 70% reduced risk of death from fatal ischemic heart disease.
By repeating the simple Omega Score “finger stick” test every two months, therapeutic progress can be validated. Patients can order the Omega Score and AA/EPA ratio test from the ALP webstore. Physicians can refer patients to the ALP webstore to order the Omega Score test, and/or physicians can register through ALP to become an Omega Score test provider and ALP will relay the physicians information to Nutrasource Diagnostics, Inc.
Which Omega 3 supplement makes the most sense?
The objective here is to increase the presence of EPA/DHA in the body, and likewise minimize the presence of AA — put this way, the answer becomes easy:
– 98% of all fats absorbed, stored, and transported in the human body are in natural triglyceride form– the supplement you take should say “natural triglyceride form” on the label – accept no substitutes;
– Enteric coating substantially increases the absorption rate of natural triglyceride fish oil preparations;
– ALP High 3 is formulated from the highest quality pharmaceutical grade fish oil — five star rated by the international Fish Oil Standards (IFOS) Organization for purity and content — look for the IFOS logo on the label;
– Because of absorption in the intestines, not the stomach, ALP High 3 achieves a significantly better absorption/penetration of omega 3 fatty acids into phospholipids (determined by red blood cell analysis), thereby boosting EPA/DHA levels, and effectively displacing arachidonic acid (AA) almost completely. Enteric coating has also been shown to reduce occasional burping, fishy aftertaste or G.I. upset.
— New enteric-coated natural triglyceride ALP High 3 provides concentrations/plasma levels/measurable efficacy at the site of inflammation.
I am concerned about the purity of fish oil preparations…the oceans have contaminants…
Good question, and you are right – ocean contaminants are a consideration. What’s in the water is in the fish. Some fish, especially shark, king mackerel, and farm-raised salmon, can be contaminated with mercury, PCBs, and other industrial and environmental chemicals/pollutants. ALP High 3 fish oils are derived from mackerel, tuna, salmon, sturgeon, mullet, bluefish, anchovies, sardines, herring, trout, and menhaden. ALP High 3 fish oil is carefully purified to reduce heavy metals, dioxins, and PCBs, in addition to being tested for oxidation levels. ALP High 3 exceeds strict international standards for guaranteed pure and potent fish oil, will always exceed the stated amounts of EPA and DHA, and is manufactured in a cGMP facility. Always insist on the IFOS five-star rating — your guarantee of quality and purity when selecting fish oil supplements.
Are there any safety issues associated with omega 3 supplements?
The only contraindication to their use is known hypersensitivity to omega 3 fish oils (such as anaphylaxis), EPA, DHA or any of its components. Care should be exercised during pregnancy or lactation, in patients facing surgery, those with bleeding problems or in patients undergoing any other treatment (either drug therapies or nutritional supplements) which may affect the ability of the blood to clot. Routine liver function tests should be performed, specifically when higher doses are being utilized. There are no known interactions with foods. Using fish oil supplements concomitantly with drugs that lower blood pressure (i.e., captopril, and enalapril, losartan, diltiazem, amlodipine, hydrochlorothiazide, furosemide, and others) may increase the effect of these drugs and may excessively lower blood pressure in some patients. The most commonly reported adverse reactions to fish oil therapy include “burping”, dyspepsia, and taste perversion.
My doctor says fish oil would be good for me. Is this because I don’t eat enough fish?
No, but it’s a good question! Our bodies can naturally manufacture the good things that fish oil provides as replacements from the fats we consume – the problem is that today’s diet is high in different kinds of fats — processed, polyunsaturated fatty acids, partially hydrogenated vegetable oil, and other types of fats — these don’t contain enough of the proper “raw materials”, and in some cases produce compounds that actually work against the production of the proper omega-3 fatty acids (the beneficial ones). ALP High 3 provides high concentrations of EPA and DHA, beneficial omega-3 fatty acids, in the natural form which our bodies can easily absorb and use.