Getting the Right Amount of Fish and Fish Oil Each Day

 James Meschino DC, MS, ROHP

In the previous two articles I reviewed the evidence showing that omega-3 fats from fish and fish oil supplementation provide many established health-promoting benefits with respect reducing risk of heart attack and other vascular diseases. The problem is that you can’t just rely on fish ingestion alone to optimize your omega-3 fat intake, as the Environmental Protection Agency (EPA) has warned the public that having more than two fish servings per week increases risk of mercury toxicity. More specifically, the EPA and Food and Drug Administration (FDA) have cautioned consumers not to ingest more than 12 oz of any types of fish on a weekly basis (two 6-oz servings), even fish with lower mercury and toxin levels (1, 2).

Fish Oil-Containing Supplement Is Mandatory
In our modern world the solution that is proving to be the safest and most effective, in regards to ensuring optimal status of omega-3 fats, is including the right dosage of a fish oil-containing supplement each day, in addition to acquiring some omega-3 fats from food.

It’s very important that the fish oil supplement you ingest each day contain the lowest possible levels of peroxides, heavy metals, dioxins, and PCBs. Companies selling fish oil supplements should have a certificate of analysis thatconfirms the purity and potency of the product.

Your fish oil-containing supplement should also yield a meaningful dose of EPA and DHA, as these are the active ingredients in fish oil that produce the greatest health-promoting benefits. For example, EPA/DHA component of a fish oil-containing supplement should be at least 50% of the total amount of fish oil. Thus, if the total fish oil amount in the supplement is 400 mg, then at least 200 mg (50%) should be comprised of EPA and DHA (usually 30% EPA/20% DHA).

In our world today the right fish oil supplement should provide ALL OF THE GOOD and Virtually NONE OF THE BAD – the bad being peroxides, heavy metals, dioxins, and PCBs and the good being the highest possible yield of EPA and DHA omega-3 fats. So, choose your fish oil-containing supplement carefully, as many fish oil supplements contain only 18% EPA and 12% DHA.

Omega-3 Dosage: How much should you ingest from fish and fish oils?
Healthy Adults – The American Heart Association (AHA) recommends that healthy adults should consume fatty fish twice per week (3).In addition, I suggest, as do many other health experts, that healthy adults should take an additional 500-1000 mg of EPA/ DHA from a fish oil-containing supplement. Remember that the typical American diet contains 14–25 times more omega–6 fats than omega–3 fats and this imbalance has been shown to contribute to the development of many common diseases, including cardiovascular disease (4, 5).

Adults withCoronary Heart Disease – For patients with established coronary heart disease (angina, previous heart attack, by-pass surgery, angioplasty etc) the AHA recommends omega-3 fatty acid supplementation (as fish oils) at a dosage  of 1 gram (1000 mg) of EPA/DHA  daily (6).

Adults with High Triglyceride Levels –For adults with high triglycerides the AHA recommends a dosage of omega-3 fatty acid supplementation  (as fish oils) of 2 – 4 grams (2000-4000 mg) EPA/DHA daily, which has been shown to lower triglycerides 20-40%.  Note that patients taking more than three grams of these fatty acids from supplements should do so only under a physician’s care and monitoring.

Adults withHigh Blood Pressure – For adults with high blood pressure manyscientists generally recommend 3 – 4 grams of EPA/DHA per day, based on the available data, but this dosage requires monitoring by a physician (7).

It is also worth reviewing the following chart to see how much EPA/DHA is provided by various fish and seafood.

Type of fish                               Serving Size        EPA/DHA Content

Source: http://my.clevelandclinic.org/heart/prevention/nutrition/omega3.aspx

In regards to eating fish and seafood be aware of the following warnings and recommendations from the EPA and FDA:

• Do not eat Shark, Swordfish, King Mackerel, or Tilefish because they contain high levels of mercury.
• Five of the most commonly eaten fish that are low in mercury are shrimp, canned light tuna, salmon, pollock, and catfish.
• Another commonly eaten fish, albacore (“white”) tuna has more mercury than canned light tuna. So, when choosing your two meals of fish and shellfish, you may eat up to 6 ounces (one average meal) of albacore tuna per week (but not two).
• Check local advisories about the safety of fish caught by family and friends in your local lakes, rivers, and coastal areas. If no advice is available, eat up to 6 ounces (one average meal) per week of fish you catch from local waters, but don’t consume any other fish during that week (8).

Omega-3 Fat Conclusion and Practical Steps:
I suggest you incorporate omega-3 fats into your lifestyle program in the  manner outlined below as an important means to improve blood flow, help prevent abnormal blood clots, and prevent cardiovascular disease in various other ways:

1. Consider eating one serving from the list of safer fishes, twice per week
2. Acquire an additional 500-1000 mg of EPA and DHA omega-3 fats each day from a high quality fish-oil containing supplement.
3. If you have known heart disease, then ingest at least 1000 mg per day of EPA and DHA from a high quality fish-oil containing supplement.
4. If you have high blood pressure or high triglycerides, then speak to your doctor about taking 3 or more grams per day of EPA and DHA (from a high quality fish-oil containing supplement), as part of your comprehensive management plan.

References:

1.Chan E.J and Cho L. What can we expect from omega-3 fatty acids.Cleveland Clinic Journal of MedicineApril 2009; 76 (4): 245-251 (http://www.ccjm.org/content/76/4/245.long )
2. 2004 EPA and FDA Advice for:http://water.epa.gov/scitech/swguidance/fishshellfish/outreach/advice_index.cfm
3. Krauss RM, Eckel RH, Howard B, Appel LJ, Daniels SR, Deckelbaum RJ, Erdman JW Jr, Kris-Etherton P, Goldberg IJ, Kotchen TA, Lichtenstein AH, Mitch WE, Mullis R, Robinson K, Wylie-Rosett J, St Jeor S, Suttie J, Tribble DL, Bazzarre TL. AHA dietary guidelines: revision 2000: A statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000;102: 2284–2299.
4. Danaei G, et al. The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors. PLoS Med 2009;6(4)
5. Raffaele De Caterina, n-3 Fatty Acids in Cardiovascular Disease, New England Journal of Medicine 2011; 364: 2439–50
6. Kris-Etherton PM, Harris WS, Appel LJ. AHA Scientific Statement: Fish consumption, fish oil, omega-3 fatty acids and cardiovascular disease. Circulation. 2002; 106: 2747–2757.
7. University of Maryland Medical Center:http://www.umm.edu/altmed/articles/omega-3-000316.htm#ixzz2BvtwYcAv
8. http://water.epa.gov/scitech/swguidance/fishshellfish/outreach/advice_index.cfm