Guide to Choosing the Best Supplement Omega-3 Supplement

Published:  03/07/2016

Health Benefits of Omega-3 Fatty Acids

Omega-3 fatty acids are associated with many health benefits. New studies are identifying potential benefits for a wide range of conditions including cancer, hypertension, cardiovascular disease, high triglycerides, anxiety and depression, bipolar disorder, eczema, asthma, osteoporosis, cognitive function and Alzheimer's, diabetes and metabolic syndrome, inflammatory bowel disease, and autoimmune diseases such as lupus and rheumatoid arthritis.

The reason omega-3s can provide all these benefits? In large enough amounts omega-3's reduce the inflammatory process that leads to many chronic conditions such as obesity, diabetes, cardiovascular disease and aging.

Because of these health benefits, there is general agreement amongst health professionals, that individuals should consume more omega-3. We need omega-3 fatty acids for many normal body functions, such as controlling blood clotting and constructing cell membranes in the brain, and since our bodies cannot make omega-3 fats, we must get them through food and/or supplementation.

Before taking omega-3 supplements check with your doctor if you have diabetes, are at risk of bleeding or on aspirin, chemotherapy drugs or blood pressure medicine. Also, don't take the supplements if you have an implanted defibrillator. Omega-3 supplements may contain shellfish. So do not take if you have an allergy to clams, scallops, shrimp, lobster, crayfish, crab, oyster, mussels, others. And, before having any laboratory test, tell your doctor and the lab staff that you are taking omega-3 supplements.

Types of Omega-3 Fatty Acids

Not all omega-3s are the same. The three main forms are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid (ALA).

The most beneficial forms of omega-3s are DHA and EPA. DHA and EPA come from animal sources: salmon, mackerel, herring, lake trout, sardines and albacore tuna. DHA and EPA are more potent and beneficial to health than ALA. Though beneficial, ALA omega-3 fatty acids have less potent health benefits than EPA and DHA. ALA omega-3s comes from plant sources. The richest sources of ALA are seeds (chia seeds, flaxseeds, flaxseed oil, hempseeds, hempseed oil) and walnuts. Other good sources are soy, phytoplankton and algae, black currant seeds, soybean oil, and canola oil and to a lesser degree, leafy green vegetables.

DHA and EPA are the forms most easily used by the body. The body can convert plant source ALA to EPA and DHA but the process is extremely slow and inefficient. Omega-3s from ALA-rich plant sources can be converted in limited amount (anywhere from 1%- 10%) by the body into primarily EPA and DHA. And if the diet is too high in omega-6 fatty acids (as in the typical American diet) this conversion is even less (about 50% less) because they compete with omega 3's for certain enzymes as they are metabolized.

If you are healthy, the standard advice is to eat fatty fish twice a week. A serving is 3.5 ounces cooked, or about ¾ cup of flaked fish, says the American Heart Association. But if you don't eat this much fish, you might want to consider taking an omega-3 supplement, especially if you have heart disease or high triglycerides.

Fish from wild, deep-water ocean fish supplies more omega-3 fatty acid than fish raised in fish farms. If you are concerned about the mercury levels, smaller fish contain less mercury than larger fish.

The American Heart Association's recommendation for supplementation has changed. The recommendations WERE If you have heart disease, the American Heart Association recommended 1 gram (1,000 milligrams) a day of EPA and DHA from fatty fish and/or fish oil supplements. For people with elevated triglycerides, it was advised to get 2 to 4 grams of EPA and DHA a day from supplements.

The American Heart Association has updated its recommendations.

Originally published  Circulation. 2017;135:e867-e884

Although evidence has raised questions about the benefits of omega-3 supplementation to PREVENT cardiovascular events, the recommendation for patients with established Coronary Heart Disease (such as a recent Myocardial Infarction) stays essentially unchanged: Treatment with omega-3 PUFA supplements is sensible for these patients.

They now recommend omega-3 supplementation patients with “prevalent heart failure without preserved left ventricular function" to reduce mortality and hospitalizations.

Although they do not recommend treatment for patients with diabetes mellitus and prediabetes to PREVENT Coronary Heart Disease, there was a lack of consensus on the recommendation for patients at high Cardiovascular Disease risk.

They do not recommend treatment to prevent incident stroke among patients at high CVD risk and recurrent Atrial Fib.

Best to talk with your doctor about your unique situation, refer your doctor to the link to American Heart Association's article as they may not be informed.

How Do You Select the Best Omega-3?

When purchasing an omega-3 supplement it is important to note the amount of EPA and DHA, not necessarily “Omega 3” or “Fish oil”. If the ingredient label simply says “fish oil concentrate” or “omega-3 fatty acids”, that isn't good enough. Look for the total amount of EPA and DHA on the label. These levels should be clearly stated on the label. If the label says, for example, “1000 mg of omega-3” then you have little idea how much DHA and EPA this contains since other fats will make up some of this 1000 mg. “1000 mg of fish oil” does not necessarily mean 1000 mg of Omega 3 fatty acids or 1000 mg EPA and DHA. Remember, it's most important to know how much EPA and DHA.

Choose a supplement that has relatively high amounts of EPA and DHA per capsule to negate the need to take several pills. Some capsules are more concentrated than others. As an example, the label may say 1,000 milligrams of “fish oil concentrate per capsule”, but the small print may show only 300 milligrams of EPA and DHA per capsule. That would mean you need to take three capsules to get about 1000 mg gram day. It would be better to find a product that provides 1000 mg of EPA and DHA in only two capsules.

Don't purchase a supplement with an “omega oil blend” (e.g., 3-6-9). You won't be getting enough of the omega-3s DHA and EPA because the product also contains omega-6 and omega-9s. Here is a sample label: “Each serving may also provide the following naturally occurring amounts of polyunsaturated fats and monounsaturated fats: Omega-3 oils: Alpha Linoleic Acid (ALA) 900 mg Omega-6 oils: Linoleic Acid and Gamma Linoleic Acid (GLA) 530 mg Omega-9 oils: Oleic Acid 350 mg.” Note that in this product the omega-3 is in the form of ALA which is hard for the body to convert to DHA and EPA.

Get the best ratio:  Mayo Clinic Professor of Medicine Dr. Stephen Kopecky recommends a 3:2 ratio of either EPA to DHA or vice-versa. According to the research, DHA outperforms EPA in reducing total triglyceride counts and increasing HDL (good) cholesterol. Alternatively, EPA has a more beneficial effect on lowering overall LDL (bad) cholesterol.

If you are purchasing a liquid fish oil supplement, look for added antioxidants on the label. The addition of antioxidants such as vitamin E is very important as they can help prevent the oil from being oxidized and damaged by free radicals once the bottle is opened. Specifically, look for alpha-tocopherol because it prevents oxidation better than tocopherol acetate. Oxidation appears not a problem for capsules.

Purity is very important, especially for pregnant and lactating women. Choose a supplement that indicates that contaminants such as mercury and PCBs have been tested for and removed.

Like all over-the-counter dietary supplements, omega-3 capsules are unregulated, so you don't really know what you are getting.

To help you in selecting the best omega-3 supplement, I have some sample labels from actual products and have commented on each one.

Supplement Facts

1 capsule

Water (including DHA/EPA) 300 mg

Maria's comments: This doesn't say exactly how much DHA or how much EPA.

Supplement Facts

1 capsule

Fish Oil Concentrate 2400 mg

Omega 3 Fatty Acids DHA and Other Omega 720 mg

Maria's comments: This doesn't say how much of the total omega-3 are contributed by DHA or EPA. And we don't know how much is from the “other Omega-3”.

Supplement Facts

1 soft gel

Omega 3 Fish Oil 1000 mg

EPA 180 mg

DHA 120 mg

Maria's comments: There is only 180 mg EPA and 120 mg DHA= 300 mg total per softgel. You would have to take 3 softgels to almost reach the 1000 mg recommendation.

Supplement Facts
Serving size 2 capsulesTotal Omega 3s 1280 mgEPA 650 mgDHA 450 mg

Other Omega 3s 180 mg

Oleic Acid (Omega 9) 56 mg

Maria's comments: This clearly states how much EPA and DHA is in 2 softgels. 650 mg + 450 = 1100 mg. And in a 3:2 ratio that is considered optimal.
Supplement FactsServing size 1 capsuleFish Oil concentrate 2400 mgOmega 3 60 mg

Omega 3  240 mg

Maria's comments: Look at this sneaky label. 2400 mg fish oil concentrate, 360 mg and 240 mg of omega-3. But from EPA, DHA or ALA?

Supplement Facts

1 capsule

Omega 3 Fatty Acids 600 mg

EPA 300 mg

DHA 200 mg

Other Omega 3 100 mg

Maria's comments: Per softgel there is 300 mg EPA and 200 mg DHA= 500 mg. And in a 3:2 ratio. You could take 2 softgels and get the recommended 1000 mg.


For more information on Omega-3 fatty acids, health benefits and research studies:

Linus Pauling Institute at Oregon State National

Center for Complementary and Alternative Medicine (NCCAM)

The Office of Dietary Supplements National Institutes of Health


Doughman SD, Krupanidhi S, Sanjeevi CB. Omega-3 fatty acids for nutrition and medicine: Considering microalgae oil as a vegetarian source of EPA and DHA. Curr Diabetes Rev. 2007;3(3):198-203.

Kusbak R, Drapeau C, van Cott E, Winter H. Blue-green algaaphanizomenon flos-aquae as a source of dietary polyunsaturated fatty acids and a hypocholesterolemic agent. Presented at: Annual Meeting of the American Chemical Society; March 21-25, 1999; Anaheim, Calif.

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Das UN. Essential fatty acids: Biochemistry, physiology, and pathology. Biotechnol J. 2006;1(4):420-439.

Burdge GC, Wootton SA. Conversion of alpha-linolenic acid to eicosapentaenoic, docosapentaenoic and docosahexaenoic acids in young women. Br J Nutr. 2002;88(4):411-420.

Burdge GC, Jones AE, Wootton SA. Eicosapentaenoic and docosapentaenoic acids are the principal products of alpha-linolenic acid metabolism in young men. Br J Nutr. 2002;88(4):355-363.

Indu M, Ghafoorunissa. n-3 fatty acids in Indian diets—comparison of the effects of precursor (alpha-linolenic acid) vs product (long-chain n-3 polyunsaturated fatty acids). Nutr Res. 1992;12:569-582.

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Harnack K, Andersen G, Somoza V. Quantitation of alpha-linolenic acid elongation to eicosapentaenoic and docosahexaenoic acid as affected by the ratio of n6/n3 fatty acids. Nutr Metab (Lond). 2009;6:8.

Doughman SD, Krupanidhi S, Sanjeevi CB. Omega-3 fatty acids for nutrition and medicine: Considering microalgae oil as a vegetarian source of EPA and DHA. Curr Diabetes Rev. 2007;3(3):198-203.

Kusbak R, Drapeau C, van Cott E, Winter H. Blue-green algaaphanizomenon flos-aquae as a source of dietary polyunsaturated fatty acids and a hypocholesterolemic agent. Presented at: Annual Meeting of the American Chemical Society; March 21-25, 1999; Anaheim, Calif.

U.S. Department of Agriculture Agricultural Research Service. USDA national nutrient database for standard reference, release 21.2008. Available at: Accessed November 2009.

Sanders T, Lewis F. Review of nutritional attributes of good oil (cold pressed hemp seed oil). King's College London Nutritional Sciences Division. 2008. Available at:

Leaf A. Prevention of sudden cardiac death by n-3 polyunsaturated fatty acids. J Cardiovasc Med. (Hagerstown). 2007; 8 Suppl 1:S27-29.

Dietary supplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. Lancet. 1999; 354:447-55.

Yokoyama M, Origasa H, Matsuzaki M, et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet. 2007; 369:1090-98.

Mozaffarian D, Ascherio A, Hu FB, et al. Interplay between different polyunsaturated fatty acids and risk of coronary heart disease in men. Circulation. 2005; 111:157-64.

Leitzmann MF, Stampfer MJ, Michaud DS, et al. Dietary intake of n-3 and n-6 fatty acids and the risk of prostate cancer. Am J Clin Nutr. 2004; 80:204-16.

Koralek DO, Peters U, Andriole G, et al. A prospective study of dietary alpha-linolenic acid and the risk of prostate cancer (United States). Cancer Causes Control. 2006; 17:783-91.

Eilander A, Hundscheid DC, Osendarp SJ, Transler C, Zock PL. Effects of n-3 long chain polyunsaturated fatty acid supplementation on visual and cognitive development throughout childhood: a review of human studies. Prostaglandins Leukot Essent Fatty Acids. 2007; 76:189-203.

Oken E, Kleinman KP, Berland WE, Simon SR, Rich-Edwards JW, Gillman MW. Decline in fish consumption among pregnant women after a national mercury advisory. Obstet Gynecol. 2003; 102:346-51.


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