T Nation

Fish Oil FAQ

In light of the recent plethora of questions on fish oil, I thought I’d get the balling rolling on a thread solely devoted to the subject.

Below, you’ll find posted an excerpt from a paper I wrote in the early 2002 for a psychology course. While for the sake of the class it contains quite a bit of information regarding utilization of fish oil in treating psychological afflictions, there’s also quite a bit of stuff in there about a host of other related stuff. Like I said, it’s somewhat old, so a lot of new information needs to be added, but that’s why I think it’ll make a good thread with lots of contributors. I’ve edited it, removed all of the references, and will paste it in several pieces so that it’ll be more readable. Hopefully, we’ll get enough material here to make it a valuable resource to those new to T-Mag.

I’ve already spoken with Cass about contributing some of her expertise on the matter; I’d encourage anyone else with information to share or questions to ask to jump in as well.

    <b>The "Skinny" on Fats</b>

The terms “fats” and “lipids” are often used interchangeably: a trend that is incorrect but continues nonetheless. In actuality, fats are a class within a large category of compounds known as lipids. This category includes triglycerides (fats and oils), phospholipids, and sterols. Triglycerides account for 95% and 99% of the lipids in foods and the body’s stores, respectively. Both phospholipids and sterols are important in cell structure, while one notorious sterol, cholesterol, is a major component of hormones, bile, and Vitamin D. Triglycerides allow the body to absorb the fat-soluble vitamins (A, D, E, and K) and help to preserve taste and texture in foods. Their functions also include fuel for the body, insulation, protection, and facilitation of carbohydrate metabolism. However, of most importance to our discussion are triglycerides’ roles in hormonal regulation and cell membrane composition. As such, we’ll focus specifically on this most common type of lipid.

A triglyceride consists of hydrogen, carbon, and oxygen atoms arranged to form a glycerol molecule and three fatty acids. The fatty acids’ structure resembles a chain consisting of anywhere from four to twenty-four carbon “links” (18-carbon chains are the most frequently occurring in human nutrition). On one end of the chain is a methyl (CH3) group; on the other end is an acid (COOH) group. Each of the carbon atoms in the chain has the potential to form four bonds. Because only two of these bonds are needed to continue the chain (on both sides of each carbon atom), the carbon atoms may also bond with one or more hydrogen atoms. However, the carbon atom may also form a double bond with an adjacent carbon atom: a scenario in which there is no longer room for one of the hydrogen atoms. Places at which there are double bonds between carbon atoms are referred to as points of unsaturation. Carbon atoms with two hydrogen atoms attached are termed saturated.

These chemical structures directly correspond to the naming of fatty acids. Saturated fatty acids exhibit the maximum amount of hydrogen atoms possible, whereas unsaturated fatty acids have at least one point of unsaturation. Unsaturated fatty acids are further divided into monounsaturated fatty acids (MUFAs), which have one point of unsaturation, and polyunsaturated fatty acids (PUFAs), which have two or more points of unsaturation. And, remember that each triglyceride consists of three fatty acids. So, when we read nutritional labels, we know that saturated fats contain mostly saturated fatty acids, unsaturated fats contain predominantly unsaturated fatty acids, and so on.

To further limit the scope of our study, we will focus specifically on PUFAs. When a PUFA’s first point of saturation is at the third carbon atom from the methyl group, the chain is known as an omega-3 fatty acid. Likewise, if the point of unsaturation is at the sixth carbon atom from the methyl group, the chain is an omega-6 fatty acid. The human body requires many different fatty acids and can make all but two of them: linoleic acid (an omega-6) and linolenic acid (an omega-3). As such, the two acids are known as essential fatty acids (EFAs); we must get them from out diet.

EFAs play important roles in the structures of cell membranes and eicosanoids, chemical compounds (similar to hormones) that regulate numerous bodily functions. Rarely will someone have difficulty getting enough linoleic acid in their diet, as meats and vegetable oils provide significant amounts. However, linolenic acid, like most omega-3 fatty acids, is a tougher nut to crack in terms of getting sufficient amounts from diet alone (especially the traditionally unhealthy diets of most Americans). This becomes a problem, as the body converts dietary linolenic acid into the two other very important omega-3 PUFAs: eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), commonly referred to as fish oils. These conversions take place in brain cells, sex glands, adrenal glands, and the inner ear (just to name a few). EPA and DHA are absolutely crucial to proper growth, development, and functioning. So, as you can probably imagine, without adequate linolenic acid in the diet, you probably won’t have the raw materials necessary to make a sufficient conversion, leaving you in an EPA and DHA deficiency. Such deficiencies have been linked to heart disease, hypertension, arthritis, cancer, immune disorders, chronic intestinal disorders, retardation of growth, liver disorders, skin lesions, reproductive failure, visual problems, kidney disorders, and last, but certainly not least, neurological disorders. In short, not eating the right stuff can set you up for some serious problems. That is, unless you can get the EPA and DHA directly from other sources…

So where can I get this stuff?

Significant amounts of linolenic acid can be found in the following oils: flaxseed, soybean, hempseed, pumpkinseed, canola, wheat germ and walnut. Products such as margarine and shortening that are derived from these oils also contain modest amounts of linolenic acid. Some nuts and seeds ? butternuts, walnuts, pumpkinseeds, and flaxseeds- and vegetables (soybeans) are good sources as well. However, the conversion of linolenic acid to EPA and DHA is not totally efficient, and it becomes even less efficient as we age. Plus, even if you eat plenty of the aforementioned foods regularly, you still might come up short on EPA and DHA because the fatty acid quality is often degraded due to the typical overprocessing that occurs in commercial production. As such, it is best to get your EPA and DHA directly whenever possible.

EPA and DHA are commonly referred to as fish oils because coldwater fish are by far the best sources. These fish include, but are not limited to: salmon, mackerel, bluefish, tuna, mullet, herring, anchovy, and sardines. Infants receive plenty of EPA and DHA from their mothers’ milk. Certainly, eating fish every day isn’t appetizing for most people, and drinking human milk after the age of one is neither feasible nor socially acceptable! Luckily, fish oil supplements in both liquid and softgel form are widely available to ensure that EPA and DHA requirements can be met easily. Therefore, although the terms EPA/DHA and fish oils are substituted for one another in writing and conversation, EPA and DHA are actually just two kinds of fatty acids contained in fish oils.

How did they think to use fish for anything except fishing?

Over the years, researchers began to note several tremendously unexpected characteristics in certain populations. In short, people who should have been in poor health were in actually in superior health. One such population was the Greenland Eskimos, who were the subject of a landmark study during the 1970s. Their diet is extremely devoid of fruits and vegetables and very high in fats from animal sources. Typically, such a diet anywhere else in the world would put them at great risk for a variety of maladies, most notably coronary heart disease (CHD). However, the Eskimos had far lower instances of CHD than a Denmark population of nearly identical ethnical composition. The Eskimo and Danish diets both consisted of a high percentage of calories from fat (39% and 42%, respectively), so why didn’t the Eskimos suffer from such CHD like the Danes and everyone else? The secret lay with the types of fat that the Eskimos were eating. The typical Danish diet consisted of 22% of total calories from saturated fat and less than 1% from omega-3 PUFAs. Meanwhile, only 9% of total calories in the Eskimo diet came from saturated fat. Perhaps more importantly, 4.2% of the Eskimos’ total calories came from omega-3 PUFAs. Likewise, similar trends were emerging in some coastal villages in Korea and Japan, and throughout Scandinavian countries. What did these villages have in common? Was it something in the water? You bet! They all relied extensively on coldwater fish in their everyday lives. These trends continue to endure today. A recent comparison of two Japanese villages: one fishing, one farming, found that the farming village had eight times more artherosclerotic plaques than their fishing counterparts. In other words, unless you’re willing to move to a fishing village in Scandinavia or the Far East, it might be a good idea to pick up some fish oil softgels or salmon on your next shopping trip!

Fish oils keep your ticker ticking!
Once it had been established that adequate EPA and DHA consumption was effective in preventing diseases and that deficiencies in these essential fatty acids were associated with poor health in several regards, the next logical step was to see how EPA and DHA could be used in treating existing illnesses. The results have been impressive thus far, and new applications of fish oil supplementation seem to be arising each day. First and foremost, fish oil has been proven extremely beneficial for heart and vascular health.

An eleven year study of 20,557 male U.S. physicians showed that those who consumed fatty fish at least once per week were 52% less likely to suffer a sudden cardiac death than those who only ate it once per month or less. Also, Harper and Jacobsen (2001) reported that randomized clinical trials with fish oils “have demonstrated reductions in risk that compare favorably with those seen in landmark secondary prevention trials with lipid-lowering drugs.” And, an American Medical Association study of 80,000 nurses between 1980 and 1994 showed that those who ate fish once per week had 22% fewer strokes than those who only ate it once per month or less. Furthermore, five servings or more per week was even more beneficial, corresponding to 50% fewer strokes. Durrington et al (2001) found that increasing fish oil consumption helped to prolong patients’ survival following heart attacks. On a related note, Italian researchers verified that PUFA supplementation in the form of fish oil supplements reduced the risk of sudden death caused by arrhythmias in heart attack survivors by 42% in the three months after the initial cardiac incident.

Fish oils’ exact mechanisms of action in decreasing CHD risk are still unknown. Postulations about these mechanisms have been made, though. Fish oils lower serum triglycerides and, in high dosages and combination with dietary modifications, low density lipoprotein (LDL) cholesterol as well. They decrease arterial platelet collection, which can lead to dangerous clots. Also, there is significant backing for the assertion that fish oils’ antiarrhymthic capacity is the most important. Without sufficient EFAs, the body is forced to make cell membranes out of saturated fatty acids, which yield membranes that are far less elastic. When cardiac cells are made from EFAs (and are thus appropriately elastic), the heart has an easier time returning to a resting state. However, the rigid cell membranes made from saturated fatty acids can cause arrhythmias and altar the cardiac muscle cell contraction.

If fish oils help the heart, they must do other good stuff, too!

These crucial PUFAs are not just needed to make cell membranes in cardiac cells, but in almost all the body’s cells. This extensive role explains why deficiencies in EPA and DHA are linked to so many seemingly unrelated disorders. It also explains why fish oil supplementation (and the restoration of normal EPA and DHA levels in the body) can be so effective in treating such disorders, including:

Rheumatoid Arthritis: In more than two dozen studies, researchers have found that fish oil supplementation reduces fatigue and stiffness in afflicted individuals. In fact, some studies found the effects to be dramatic enough to allow for substantial decreases in nonsteroidal anti-inflammatory drug (NSAID) dosages (Robbins, 2001). Furthermore, patients who supplemented with Vitamin E and fish oil showed an even greater decrease in NSAID requirements, indicating a synergistic effect between the two.

Prostate Cancer: A longitudinal study of 6,200 Swedish men showed that those who regularly consumed fish were approximately 50% less likely to be diagnosed with prostate cancer and roughly 70% less likely to die from it than those who avoided fish. Three servings per week appeared to be the minimum amount needed to attain such benefits. Additionally, the same researcher is currently examining whether fish oils can also be effective in preventing breast and uterine cancers.

Ulceratic Colitis, Crohn’s Disease, and Irritable Bowel Syndrome: Results from a recent study published in The New England Journal of Medicine indicate that when patients with these disorders took omega-3 fatty acid supplements along with their medications, they were almost always symptom-free. Researchers at the University of Granada in Spain found that colitis-infected rats showed the lowest extent of colon damage when they were treated with EPA and DHA supplements.

Kidney Disease: Researchers at the Mayo Nephrology Collaborative Clinic found that fish oils slowed the progression of immunoglobin A nephropathy in patients at a high risk for kidney disease. Omega-3s have also shown promise in reducing urinary calcium levels in kidney stone patients and preventing blood clots in hemodialysis patients. The side effects (such as skin lesions and hyperlipidemia) of cyclosporine, a medication often prescribed for kidney transplant patients, are noticeably less significant when patients supplement with fish oil.

Bronchial Asthma: Nagakura et al (2000) found that ten months of EPA and DHA supplementation lessened asthma symptoms and acetylcholine sensitivity in 29 children with severe bronchial asthma (in collaboration with a controlled environment and diet).

Menstrual Symptoms: In a Danish study, fish oil, in combination with Vitamin B12, proved effective in alleviating menstrual pains significantly. Although not as effective as the combination treatment, fish oil alone also proved to be appreciably effective. The research was undertaken because women prone to menstrual discomfort are often found to have omega-3 deficiencies. The body needs omega-3s to create type-3 prostaglandins. These compounds are similar to hormones, controlling uterine contractions and pains.

EPA and DHA in the Brain? Something’s fishy?

Perhaps the most dreaded potential consequences of EPA and DHA deficiencies are the psychological disorders that many scientists believe result from a lack of EFAs. Recall that the composition of the body’s cell membranes (saturated fatty acids versus PUFAs) determines the elasticity of the cell and how it functions. Brain cells are no different; fat comprises approximately two-thirds of the brain. Most importantly, EFAs account for 45% of the fatty acids in the synaptic membranes. Bruinsma and Taren (2000) reported that omega-3 derived fatty acids “control the membrane fluidity, enzymatic activities, binding between molecules and receptors, biochemical interactions, and movement of nutrients.” They also found that a decrease in “dietary PUFAs could disrupt cell membrane composition and structure, thereby causing alterations in membrane-bound receptor function and enzymatic activity.” English translation? Brain cells (and all neurons in the central nervous system, for that matter) need to communicate. They do so chemically by exchanging neurotransmitters. In order to move from one cell to the next, the neurotransmitters pass through two fatty acid layers (the membrane of each cell). When these membranes are made from essential fatty acids, they’re sufficiently elastic, so the neurotransmitters usually experience smooth sailing. On the other hand, when the membranes are made with saturated fatty acids, stormy seas are ahead for the neurotransmitters. Membranes comprised of saturated fatty acids are inflexible; the result is essentially a neurotransmitter “clog,” as these important chemicals struggle to get through inelastic membranes.

So where does this “clog” leave us? Well, when the number of neurotransmitters in the synapic gaps is out of whack, we’re out of whack, too! The neurotransmitter most prominently affected by EPA and DHA is serotonin (although dopamine levels are also significantly impacted). Again, Bruinsma and Taren (2000) stated,

“Alterations in the serotonin system in particular play a critical role in
the development of depression. As the binding between individual
neurotransmitters and their receptors takes place in the neuronal
membranes (a necessary step in the transfer of neuronal signals),
any change that inhibits this process might block the neuronal messages
and decrease the level of available neurotransmitters.”

Do you need a real life application of what they are trying to say? Here goes: next time that you chow down on a greasy corn dog that was fried in pure lard, remember that you are basically consuming the “Anti-Prozac.” Prozac, a selective serotonin reuptake inhibitor (SSRI), improves mood and lessens depression by preventing the neurons from taking in serotonin from the synaptic gaps, effectively increasing serotonin levels in these gaps. In contrast, the saturated fatty acids in your beloved corn dog prevent the serotonin from ever getting out of the neurons in the first place!

Treating Mental Illnesses with Fish Oils: the Next Frontier

Restoring EPA and DHA levels in the brain can help to alleviate the symptoms of many mental illnesses and perhaps even cure them altogether. Although considerably more research is needed before specific EPA and DHA dosage recommendations can be made, several studies’ successful outcomes indicate that fish oil supplementation may indeed be the “next frontier.”

There is little doubt that EPA and DHA levels in the brain are directly associated with depression. In areas where EFA consumption is high, depression is usually low. EFA deficiency states (postpartum period and alcoholism, for example) also frequently coincide with times of depression.

The most avid proponent of fish oil supplementation in treating mental illness is Dr. Andrew Stoll, director of the Psychopharmacology Research Laboratory at Harvard Medical School-McLean Hospital in Belmont, Massachusetts. Stoll, who also wrote The Omega-3 Connection, has supervised some of the most influential studies regarding fish oils and depression.

Stoll’s initial double blind, controlled study included 44 individuals who suffered from bipolar affective disorder. Also known as manic depression, bipolar disorder is characterized by alternating phases of severe depression and manic overdrive. Each day, Stoll and his colleagues gave the experimental group ten grams of fish oil ? the equivalent of more than four pounds of fatty fish- while the control group received a placebo (olive oil). After four months, the experimental group showed dramatic improvements: less intense depression, improved sleep quality, and reduced agitation and aggression. In fact, the results were so dramatic that the control group was immediately given the fish oil treatment as well.

Stoll replicated his findings later in another study where thirty bipolar volunteers were given either fourteen fish oil capsules or an olive oil placebo every day for four months. Those taking fish oil with their medications showed fewer symptoms than those only taking their medications. And, in the patients not taking any antidepressants, those who received fish oil were symptom-free for longer than those taking the placebo.

At this point, treating unipolar depression with fish oils is still unchartered waters. Unipolar depression differs from bipolar depression in that it alternates periods of normal moods (rather than mania) with deep depression. However, there is still hope, as fish oils seem to have been effective in treating one individual: a 21-year old male who had suffered from severe unipolar depression for seven years. According to the researchers, “At age 19 years, pharmacotherapy was commenced owing to increasing illness severity, with prominent low self-esteem, insomnia, sadness, inner tension, poor appetite, poor concentration, increasing social phobia, lethargy, pessimistic thoughts, and suicidal thoughts.” The patient had been completed unresponsive to antidepressants, hypnotics, lithium carbonate, and antipsychotic medications. As what was essentially a last resort, the patient agreed to combine fish oil (in the form of ethyl-EPA) to his current medications. The immediate results were nothing short of amazing. Puri et al (2001) reported, “Administration of ethyl-EPA led to a dramatic improvement, including cessation of the previously unremitting severe suicidal ideation, within one month. Symptoms of social phobia also improved dramatically.” And, “Both he and his mother reported how different he had become. He no longer had any suicidal thoughts and was actively making plans for his future studies and career. The patient reported no adverse side effects of the medication.” So there you have it: immediate outstanding results with no side effects. Not only does this case pave the way for more studies to test the efficacy of fish oils in treating unipolar disorder, but it also shows that fish oil might even be the closest thing to a quick fix that you’ll ever see! Sure beats your “24-Hour Miracle Diet,” doesn’t it?

So what can fish oils do for me?

As you can imagine, people use fish oil supplements for a variety of purposes. While these supplements are obviously effective in treating some disorder, they play an equally important role in prevention. You mustn’t look any further than my own family for such evidence. As an aspiring bodybuilder, I follow a diet that is high in protein and, sometimes as a result, high in cholesterol. Although I eat plenty of “heart healthy” food (fruits, vegetables, and whole grains), I also religiously consume 6g of EPA/DHA per day as well as plenty of linolenic acid from various sources, particularly flaxseed oil, as preventative measures. By watching my saturated fat intake and getting enough EPA and DHA, I am able to easily keep my cholesterol levels in the ideal range while meeting my desired protein intake. Also, the bodybuilding lifestyle is tremendously cyclical in that one alternates between “bulking” and “cutting” phases, manipulating training and diet to achieve a desired physique effect (mass gain or fat loss). This lifestyle can wreak havoc with one’s psychological status, which explains why so many people cannot endure the “bodybuilding way” (or any ordinary fat loss diet, for that matter). Many people simply cut out dietary fats when they want to lose weight and wind up moody and irritable as a result. After reading this paper, logic alone should tell you that eliminating essential fatty acids is the worst thing that you can do if you want to be happy! Skip the healthy fats, and your serotonin levels will drop, leaving you depressed. Skip the saturated fats and keep the EPA and DHA coming, though, and you’ll be all smiles as you shed the extra pounds. I know that I am not prone to emotional highs and lows based on my diet. Obviously, this is due in part experience, but I suspect that it also has a lot to do with my EPA and DHA consumption regulating serotonin production.

Meanwhile, I have my entire family taking fish oil softgels. In combination with improved dietary and physical activity habits, fish oils have helped my father to the lowest cholesterol, blood pressure, and fasting blood glucose levels that he has had in years. For the rest of my family, it’s purely a matter of prevention. I wouldn’t have it any other way.

Roman’s hanging at my house this weekend, and he forgot to log out. Those last several posts should have been under my name. My bad.

absolutely beautiful EC!! Yet again, another classic case of you showing your true merit. I cut and pasted the entire article and it will soon be a welcome addition to one of my 3 ring binders…haha. Great job my man. TOny G

Roman/EC
What are your recommendations for anti-oxidants when using PUFAs?

LV 426

Thanks for the great info. Hope everyone is printing this off. My printer is busting it’s balls right now. Yes my printer has BALLS!!! :wink:

lv 426,

I can’t say that I have specific antioxidant recommendations for PUFA “users” simply because I feel that everyone should be using them. That said, IMO, you should have plenty of fresh veggies in your diet as well as at least 2g vitamin C (in 500mg doses, including post-workout), 400-800IU vitamin E (one of which is post-workout), and a multi. These recommendations do change, however, during times of stress, sickness, and intense training.

EC… well done.

Thanks a ton for the mega-info!

Very informative.

Just thought I’d mention that 52 days is about the amount of time you should expect to wait before concentrations of EPA/DHA reach a level high enough to yield significant benefit.

Anyone else have anything to add?

Can fish oil bother some people. When I take it it upsets my stomach? Any ideas why?

Erica,

Definitely, and I don’t think anyone knows why. I’d say that roughly 5-10% of the people I encounter that take it get some kind of GI distress or fish burps. A good solution for this is to take most (if not all) of your EPA/DHA in your pre-bed meal. Contrary to popular belief, there’s no need to spread it throughout the day, as single dosages will get your concentrations up over time (probably more quickly than spreading it out).