What are the guidelines for choosing an over-the-counter omega-3 fatty acid supplement, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)?

From the Guidelines

When choosing an over-the-counter omega-3 fatty acid supplement, look for products that clearly specify the amounts of EPA and DHA per serving, aiming for a combined total of 1000 mg per day, as recommended by the American Heart Association for patients with documented coronary heart disease 1. To ensure the quality and efficacy of the supplement, consider the following factors:

• Select supplements made from fish oil, algal oil (for vegetarians), or krill oil, with fish oil being the most common and cost-effective option.
• Choose products with third-party testing certification from organizations like USP, NSF, or IFOS to ensure purity and potency.
• Consider the form of the omega-3s, with triglyceride forms being better absorbed than ethyl esters, as suggested by the benefits of omega-3 fatty acids on cardiovascular disease 1.
• Enteric-coated capsules can reduce fishy aftertaste and burping.
• Check for freshness by avoiding products with a rancid smell, and store supplements in cool, dark places. It is essential to note that while the ideal amount of omega-3 fatty acids to take is not firmly established, evidence from prospective secondary prevention studies suggests that intakes of EPA and DHA ranging from 0.5 to 1.8 grams per day significantly reduce the number of deaths from heart disease and all causes 1. The American Heart Association recommends consuming at least two servings of fish (particularly fatty fish) per week, which can provide the necessary amounts of EPA and DHA, but for those who prefer supplements, following these guidelines can help ensure a quality product 1.

From the Research

Guidelines for Choosing an Over-the-Counter Omega-3 Fatty Acid Supplement

When choosing an over-the-counter omega-3 fatty acid supplement, there are several factors to consider:

• The type of omega-3 fatty acids present, specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) 2, 3, 4
• The dosage of EPA and DHA, with effective doses ranging from 1,000-1,500 mg/d for at least 12 weeks 4
• The form of the supplement, with triglycerides being more bioavailable than other formulas 4
• The potential for variable content, labeling inconsistencies, and poor product quality/impurity in dietary supplements 3, 5
• The difference between prescription and dietary supplement omega-3 fatty acid products, with prescription products being supported by robust clinical development and safety monitoring programs 3, 5

Key Considerations

Some key considerations when selecting an omega-3 fatty acid supplement include:

• Checking the label for the amount of EPA and DHA per serving
• Looking for products that have been tested for purity and potency
• Considering the source of the omega-3 fatty acids, such as algal oil or fish oil
• Being aware of the potential for interactions with other medications or health conditions
• Recognizing that dietary supplements are not regulated in the same way as prescription medications, and may not be subject to the same standards of safety and efficacy 3, 5

Bioavailability and Conversion

The bioavailability and conversion of omega-3 fatty acids can also impact their effectiveness:

• Microalgal oil supplementation has been shown to increase omega-3 index levels 2
• High dose flaxseed or echium seed oil supplements may not increase omega-3 index levels, and may even reduce them 2
• The conversion of alpha-linolenic acid (ALA) to EPA and DHA can be limited, and may not provide the same benefits as direct supplementation with EPA and DHA 2, 6