What over-the-counter (OTC) omega-3 fatty acid supplement is recommended?

From the Guidelines

For over-the-counter omega-3 supplements, I recommend Nordic Naturals Ultimate Omega, Nature Made Fish Oil, or Kirkland Signature Fish Oil, with a combined total of 1000-2000 mg daily of EPA and DHA for general health benefits, as supported by the American Heart Association's recommendation of 2 to 4 g of EPA plus DHA per day for patients who need to lower their triglyceride level 1. When selecting an over-the-counter omega-3 supplement, consider the following key factors:

• Look for products containing both EPA and DHA fatty acids
• Check for third-party testing certification, such as USP or IFOS, to ensure purity and potency
• Liquid forms may offer better absorption than capsules, but may have a fishy taste
• Take supplements with meals to improve absorption and reduce digestive discomfort
• Omega-3s have been shown to reduce inflammation, support heart and brain health, and may help lower triglycerides, although the evidence for their effectiveness in reducing ASCVD risk is mixed 1
• For vegetarians or those avoiding fish products, algae-based omega-3 supplements like Nordic Naturals Algae Omega provide a good alternative It is essential to note that nonprescription fish oil products are not interchangeable with prescription omega-3 products, and their content and quality can vary significantly 1. Additionally, while omega-3 supplements may have benefits, they have not been demonstrated to have cardiovascular outcomes benefits and are not recommended for ASCVD risk reduction 1. When purchasing omega-3 supplements, be aware that they may contain impurities, including saturated fat and oxidized lipids, contaminants, or other ingredients that may be harmful 1. Start with a lower dose and gradually increase to minimize potential side effects like fishy aftertaste or mild digestive issues.

From the FDA Drug Label

Supplement Facts Dietary Supplement Serving Size: 1 Softgel Servings Per Container: 90 Amount Per Serving% Daily Value Calories Calories from Fat Total Fat Fish Oil (from Anchovies (Engraulidae) and Mackerel (Somberomorus) Fatty Acid CompositionTotal Omega-3 fatty acids EPA (eicosapentaenoic acid) DHA (doosahexaenoic acid) Other Omega-3 fatty acids 1515 1.5g 1400 mg 910mg 448mg 308mg 154mg 3%* ** ** ** ** Other ingredients: Gelatin, glyerin, water, natural lemon oil flavors, and IPP non-GMO mixed tocopherols. The FDA drug label does not answer the question.

From the Research

Omega-3 Fatty Acid Supplements

• There are various over-the-counter (OTC) omega-3 fatty acid supplements available, but it is essential to note that they are not US FDA-approved and are not required to demonstrate safety and efficacy prior to marketing 2.
• A scoping review found that supplementation with 1,000-1,500 mg/d of EPA plus DHA as triglycerides for at least 12 weeks can improve the omega-3 index to recommended levels 3.
• The American Heart Association recommends consuming fatty fish at least twice a week, but for those who cannot get enough omega-3s from their diet, supplements may be considered 4.

Recommended Omega-3 Supplements

• High-purity eicosapentaenoic acid (EPA) ethyl ester and EPA/docosahexaenoic acid (DHA) preparations have been developed primarily for the treatment of hypertriglyceridemia 5.
• The REDUCE-IT study showed a relative reduction in cardiovascular events with a high dose of high-purity EPA preparation, but the STRENGTH study did not support this benefit with a high dose of EPA/DHA preparation 5.
• Current guidelines endorse the use of icosapent ethyl (IPE), a highly-purified, high-dose form of EPA, in statin-treated patients at high cardiovascular risk who have triglycerides >135 mg/dl 6.

Key Considerations

• When choosing an OTC omega-3 supplement, consider the chemical composition, with triglycerides being more bioavailable and effective than other formulas 3.
• Be aware that EPA and DHA levels may vary widely within and between brands, and products may contain unwanted cholesterol or fats, toxins, or oxidized fatty acids 2.
• It is crucial to consult with a healthcare professional before taking any supplement, especially if you have a medical condition or are taking medications 2, 4, 5, 6.