Fish Oil

Uses and Choosing the Best Product

There is much to know about fish oil. Why should I take it and what is the correct dose? What should I look for when purchasing a product? How do I know it is safe? Let's start from the beginning.

Why take fish oil?
Long-chain polyunsaturated fatty acids are an essential part of our diet. Marine vertebrates are the main source of omega-3 fatty acids which contains EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). EPA and DHA are eicosanoids (signaling molecules) that are known to decrease inflammation throughout the body and have overall health benefits due to their involvement in many bodily processes. Inflammation is a well-researched cause of many types of illness, thus reducing it can be one of the best methods of preventing disease (1).

Heart disease has been the most well researched area for use of fish oil. Studies have shown that fish oil can reduce risk of arrhythmias, decrease triglycerides, lower blood pressure and slow growth rate of atherosclerotic plaques (2).

Joint health is affected by inflammation thus fish oil has been found to be beneficial in reducing pro-inflammatory elements in white blood cells and improving pain from rheumatoid arthritis (3) and osteoarthritis (4).

Skin conditions including psoriasis, acne, eczema, dermatitis all are improved with use of essential fatty acids. Often the body is deficient in these important skin nutrients and once increased in the diet along with other dietary adjustments can resolve or greatly improve the condition. Hallmark signs of deficiency include dry, scaly, itchy skin (5).

Mental health is one of the newer promising areas of study with the utilization of fish oil. Bipolar disorder and depression have both been studied and mood and mood swings have both shown improvement with use of fish oil (6,7).

Other areas that essential fatty acids support the body are immunity including allergies, eye health and fetal development.

Dosing
Dosing varies based on condition and body weight. Generally I recommend a total of EPA/DHA 1000mg-4000mg daily. This is not the Total omega-3 or total fish oil dose you see on the label. Always look to see how much EPA and DHA are in the fish oil and take enough of the liquid or capsules to ensure you get the recommended dose. (See Nordic Naturals liquid fish oil label below. The total EPA/DHA is 1375mg per 1 Teaspoon.)

Capsules or Liquid
Either are fine. The capsules will dissolve and are as available to your digestive tract as the liquid. The capsules are easier to take for some people who don't like the fishy taste or texture of the liquid. I often recommend taking your oil at night before bed if burping of fish flavor is an issue for you. You won't notice this in your sleep!

Storage
Always keep your fish oil in the refrigerator once it is opened to prevent your oil from going rancid. If the oil smells rancid do not use it as it has oxidized and you don't want to add oxidative stress to your body.

Safety
It has become clear that sourcing quality fish to make fish oil is of paramount priority. As our oceans have become more polluted with chemicals and metals, which fish then contain in their body and organs, having a high standard of choosing fish and processing the oil is necessary. Knowing the practices of the company you choose your fish oil from is the first place to start. High quality fish oil generally comes from cod liver and fish that are small such as sardines and anchovies as they are abundant in EPA and DHA and low in heavy metals. Companies that test every batch of their product assures to a greater extent that the fish oil is free of harmful chemicals and metals. Also, companies that have third-party testing outside of their own facility assures proper data for the product.

Sustainable fishing practices are also an important area with regards to production. The supply of fish in our seas is threatened due to overfishing, thus purchasing a high quality fish oil from a company that also focuses on sustainable fish harvesting supports the ongoing availability of this source of essential fatty acids.

Companies I recommend are Nordic Naturals, Vital Nutrients and Carlson's.

For more information on sustainable fishing practices and safety check the International Fish Oil Standards Program (IFOS) http://www.iffo.net/.

Side Effects
Fish oil is safe for most people including pregnant and breast-feeding women. At low doses (1-3mg) side effects are generally not noted aside from the possibility of digestive upset. At higher doses >3g blood clotting may be affected and there may be an increased risk of bleeding. Discuss taking fish oil with your doctor if you are on a blood thinning medication such as coumadin, have a clotting disorder or are having surgery.

References

1. Am J Clinical Nutr. 2008 Jun;87(6):1978S-80S.

2. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp

3. Arthritis Rheum. 1995 Aug;38(8):1107-14.
4. Osteoarthritis and Cartilage. 2011 Sept;19(9):1150-1157.
5. Dermatoendocrinol. 2009 Sep-Oct; 1(5): 262-267.
6. Curr Opin Psychiatry. 2013 Jan;26(1):33-40.
7. Translational Psychiatry (2001)1.

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Inflammation

A Silent Cause of Chronic Disease

Inflammation seems to be a popular word in current health literature and for good reason. Evidence now supports chronic inflammation as a root cause of several of our common diseases such as cardiovascular disease, Alzheimer's, type II diabetes and cancer. The burden of inflammation on our health status has been recognized by the health industry and measures to address the underlying cause has become a topic of focus.

Low-grade chronic or systemic inflammation, unlike acute inflammation, acts as an underlying constant irritant to the body and its cells. Acute inflammation resolves as an injury heals whereas chronic inflammation resides in the tissues on a constant basis leading to dysfunction of cells and eventually organs and vessels.

There are a milieu of immune cells active in the body including macrophages and lymphocytes as well as proteins called cytokines and chemokines directing cellular inflammation(1). Other pro-inflammatory instigators include oxidized LDL, prostaglandins and NF kappa-beta.

Chronic inflammation can be triggered by cellular stress or dysfunction such as from free radicals causing oxidative stress (ie from smoking, stress or pollutants) or elevated blood sugar levels. It is now known that this chronic stress on the cells leads to a silent degeneration and loss of physiologic function.

Assessing your risk
Good markers that are inexpensive to test for inflammation risk include:

• CRP-hs 
• Fibrinogen 

Cytokine testing can also be done which is more expensive but provides information on specific factors causing systemic inflammation.

• Tumor necrosis factor alpha 
• Interleukin-1 beta 
• Interleukin-6 
• Interleukin-8 

Additionally, testing glucose, lipid panel and homocysteine will add additional information.

Preventing and managing inflammation

Diet

It goes without saying that a healthy diet is mandatory in order to prevent low-grade chronic inflammation in the body. An anti-inflammatory diet has been described in several ways but mainly consists of a whole foods diet, focusing on lean meats, fish, legumes, nuts, seeds, fruits, vegetables and whole grains. It is wise to avoid processed foods, cured meats, sugar, excessive alcohol, caffeine and fried foods. Additionally, an anti-inflammatory diet recommends avoiding foods that may be allergens to you as an individual such as gluten, dairy, soy, nightshades (tomatoes, potatoes, peppers etc), eggs or citrus. 

Dr. Jessica Black's: The Anti-inflammation Diet and Recipe Book is an easy to use reference book to help you get started.

http://theantiinflammationdiet.com/

Environmental toxins
The environment contains ever increasing pollutants in the air we breathe, water we drink and soil we grow our food in. Many of these harmful chemicals have been found to be endocrine disruptors and neurotoxins. There are methods to help protect yourself from these harmful chemicals. Make your home a chemical free zone. Choose household products that are chemical free, drink filtered water, choose whole, unprocessed organic or pasture-fed foods and avoid pesticides in your garden and yard.
See the CDCs Healthy House Reference Manual for more details on how to support a healthy home environment and the Multipure water filter which I recommend.
http://www.cdc.gov/nceh/publications/books/housing/housing.htm
http://www.multipure.com/

Obesity
Obesity is associated with low grade chronic inflammation which is predominately driven by adipose tissue macrophages(2). Maintaining a Body Mass Index/BMI (a calculation using weight and height to measure body fat) below 25 is a general guide to use for a healthy body weight.
Calculate your BMI here: http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

Sleep
Alterations in sleep due to lifestyle factors, the aging process, and disease states have all been associated with increases in a range of inflammatory markers including monocytes, C-Reactive Protein, Natural killer cells (NK), and IL-6(3). Adults need 7-9 hours of sleep per night. See my article on The 4 Pillars for sleep support.

Smoking
Smoking increases inflammation as reflected by the elevation of serum inflammatory markers such as fibrinogen, white blood cells and CRP(4). Smoking is the single largest preventable cause of disease and premature death according to the World Health Organization. Data gathered on over 15,000 smokers in one study showed smoking-associated inflammatory response returned to normal within 5 years after smokers quit thus reducing health risks associated with smoking(5).
View this article for using acupuncture to support smoking cessation.
https://www.acufinder.com/Acupuncture+Information/Detail/Quit+Smoking+with+Acupuncture

Make the Change
Reducing risk factors with lifestyle modification is the best method to decrease inflammatory load in your body. In addition, supplementing with a high quality fish oil, eating or supplementing with spices such as tumeric, ginger and boswellia are a great adjunct to managing chronic inflammation. Make the necessary changes to your lifestyle to affect the inflammatory process and potentially live a longer and healthier life free of chronic illness.

References
1. Chronic inflammation and oxidative stress in human carcinogenesis. Int J of Cancer. 2007 Dec 1;121(11):2381-6.
2. Obesity, Inflammation, Insulin Resistance. A Mini Review. Gerontology 2009;55:379-386.
3. Sleep and Inflammation. Nutrition Reviews. Dec 2007;65:S244-S252.
4. Immunotoxicity, Immune Dysfunction, and Chronic Disease. Arnson et al. 2010;p198-199.
5. PLos Med 2005. June; 2(6):e198.
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