What dosage of EPA and DHA should I recommend to my patients?

While there is no established Adequate Intake (AI) or Dietary Reference Intake (DRI) in the United States for EPA and DHA omega-3s, a number of expert bodies and health professionals recommend 250 mg to 500 mg of EPA and DHA per day for basic health maintenance. Please refer to the chart below for additional recommendations. 

Cardio continuum chart 

What are good sources of EPA and DHA?

The best source of EPA and DHA omega-3s is fatty fish such as salmon, mackerel or tuna. Most Americans, however, do not consume enough fatty fish to reap the benefits of omega-3 consumption and in these cases, a high quality supplement or omega-3 fortified food can provide the necessary intake. Please click here for more details.

 

What if my patients want to take ALA instead?

ALA (alpha-linolenic acid) is a true “essential” omega-3 because our bodies can’t make it on its own. ALA is a precursor to EPA and DHA, but the conversion rate in our bodies is extremely low

The long-chain omega-3s EPA and DHA are known for supporting heart, brain and eye health at all stages of life so it’s important to encourage your patients to consume preformed EPA and DHA, naturally found in marine based foods and dietary supplements, directly.

 

What is the upper limit for omega-3 intake?

The US FDA has stated that up to 3g of EPA +DHA per day is Generally Recognized as Safe (GRAS), while the European Food Safety Authority (EFSA) reported no safety issues with consumption of up to 5g of EPA + DHA per day.

 

Should my patients be concerned about contaminants in fish?

The benefits of fish consumption far outweigh the potential risks when the amount of fish eaten is within the recommendations established by the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA).  The most recent FDA and EPA recommendations suggest that pregnant women and children should eat more fish due to its health benefits.

Some fish, like wild salmon, have lower levels of contaminants than fish like swordfish and tilefish, so educating your patients about what fish have low levels of contaminants is important.  They can learn more from Monterey Bay Aquarium Seafood Watch.

In terms of omega-3 dietary supplements, manufacturers purify oils to reduce levels of environmental contaminates in finished products. While governmental quality standards exist, most companies follow even stricter voluntary guidelines put forth in the GOED monograph (link) to ensure high quality and safe products.

 

Is there a bleeding risk associated with omega-3s?

The risk of bleeding is minimal. In fact, the recent science advisory from the American Heart Association entitled “Omega-3 Polyunsaturated Fatty Acid (Fish Oil) Supplementation and the Prevention of Clinical Cardiovascular Disease”[1] reported the risk of bleeding associated with omega-3 supplementation was low in the RCTs of clinical cardiovascular outcomes and presented “no apparent risk.”  In addition, the FDA’s Adverse Event Reporting System, which includes data on abnormal or prolonged bleeding associated with fish oil, includes only two such reports out of 69,732 total adverse events from 2004 to March 2016.

 

Why have there recently been negative or neutral studies on omega-3s and cardiovascular outcomes?

There are more than 30,000 published studies on omega-3s, including more than 3700 randomized controlled trials. Yet a few recent studies have reported neutral or null results, leading to confusion and doubts about the benefits of omega-3 intake. It’s important to note that in these later studies, the subjects’ baseline omega-3 status is largely unknown, which may confound the results if a portion of the subjects were already at cardio-protective levels. In addition, in the last couple of decades the standard of medical care for cardiovascular health has changed significantly, with the introduction or widespread usage of a number of medications, including aspirin, statins and beta-blockers. Participants in newer trials have better cardiovascular care and prevention, and this makes it much more difficult to isolate the protective effect of a single factor, like fish consumption or long-chain omega-3 intake.

  

Do omega-3s reduce cholesterol? 

EPA and DHA omega-3s do not lower total or LDL cholesterol. Studies have consistently shown that omega-3s help maintain normal triglyceride levels though.

 

Does it matter if my patients consume EPA and DHA from fish oil, krill or algae supplements?

The source of omega-3s is not important and supplements from fish varieties, krill or algae confer a similar benefit. The important thing is to look at the EPA and DHA content on the Supplement Facts panel of any omega-3 supplement to make sure that you are getting the recommended dosage of total EPA and DHA. Vegetarians and vegans can choose an algae-based supplement.

  

Other than cardiovascular protection, what are other benefits from omega-3 consumption?

In addition to cardiovascular benefits, there is a strong body of science supporting the role of omega-3s in cognitive function, eye health and fetal development. Please click here for more information.

 

Can my patients get their omega-3 levels tested?

Patients can have their omega-3 or fatty acid levels to help you understand educate them about their omega-3 status and consumption needs. Below are several omega-3 test kit options: