Supplement Detective

By Curtis Alexander, Pharm.D.

Summary: Selecting the best fish oil can get a little tricky because some manufacturers tend to leave out information on their labels.  To select the best fish oil brand for you and your family focus on these basics and not for marketing hype.

Q: My husband and I are convinced that we need to be taking a fish oil.  But with so many on the market and all the claims and DHA this, EPA that it gets confusing.  Any advice on selecting the best fish oil supplement for our particular needs?

A: The main reason most folks want to start taking fish oil is because of omega 3 fatty acids.  That’s good.  And, something you are probably very aware of.  However, I mention it first just as a reminder that one of the best, and most effective ways, to increase your omega 3 to omega 6 ratio’s is to cut out the typical American fare in your diet.

Secondly, naturally add in more omega 3’s to improve the ratio even further.  Of course, one of the questions that immediately comes up is which foods?  Surprise, surprise … fish is one of the biggest ones.  But, some people aren’t big fish eaters or, for a hundred other reasons, have a hard time getting their omega 3’s through diet.  Then it’s on to manufactured fish oils.

Tip-Offs to the Best Fish Oils

If you’ve done that and are still looking to navigate through the claims of best fish oil supplements then here is my basic advice.

1. Be wary of labeling claims. I’ve written before about terms that manufacturers will use to ‘pump up’ their marketing like “pharmaceutical grade“.  I have yet had a manufacturer give me evidence that shows this is nothing more than a made-up term used to sell more supplements.
2. It’s helpful if your fish oil supplement lists the type of fish used to make the oil. Smaller fish like anchovies and sardines are some of the best sources of omega 3’s.
3. Make sure that the fish oil you select lists the amounts of both EPA and DHA on the label. If they don’t separate them out in the nutrition facts labeling don’t buy that product because you really don’t know what you are getting.
   While this isn’t as easily done as said … try to find a fish oil supplement that not only lists the species of fish used but one that also screens their catches to make sure they are disease free and lists the waters that they are caught from.
4. There’s a lot of concern about purity in fish oils. I understand that but sometimes focus on the words “100% pure” can lead to the same sort of labeling claims that I talked about above.  Nearly every manufacturer will claim 100% pure.  It’s non-specific but sounds impressive.  Also, a lot of manufacturers will claim that this means their particular fish oil has no mercury or other heavy metals in it.  I’ve written before about consumers thinking that this is a serious side effect of fish oil, but it really shouldn’t be.  By all means though, if you have limited your choices down to two and one claims to have 100% purity and it makes you feel better – go for it.  Just realize that, in my opinion, this sort of labeling can be misleading.
5. Third Party Tested. I’ve seen fish oils that use third parties to verify freshness and purity (heavy metals, dioxins and PCB’s).  I generally think this is a good idea.  However, don’t place too much emphasis on this as they don’t say WHO this third party is.  Is it a subsidiary of their own company or a truly independent third party?
6. Taste. A lot of people find they can’t tolerate taking even the best fish oil supplements because of the fishy taste and burps they sometimes get.  It is possible to minimize some of the bothersome side effects of fish oils.  Also, my wife Jodi was really sensitive to the fishy taste.  One brand she had good luck with was Nordic Naturals Ultimate Omega.  But, sometimes patients still can’t tolerate it and decide to go to a plant-based omega 3 supplement.  From the evidence I’ve seen thus far you’ll be wasting your time and money.  If you want to improve your omega 3 profiles the most effective way is through a fish-based product.  Plant based product do provide you with ALA (Alpha Linoleic Acid) which is a precursor to EPA and DHA.
   Two problems though: ALA is converted very inefficiently to EPA and DHA (studies show less than 1%).  Also, the ALA in those products comes from flax seed.  I’ve become critical of flax seed and the claims surrounding it in recent years.  Especially for men.

While this gives you a lot to think about in regards to selecting the best fish oils here are some warnings for YOU before you decide to take any fish oils:

• Make sure you don’t have an allergy to iodine.
• You should NOT be using blood thinners while taking fish oils (i.e., warfarin (Coumadin), Plavix, aspirin, etc.)
• Notify your doctor if you are scheduled for any sort of surgery that you are taking a fish oil supplement.
• Other ingredients.  While it’s important to know the amounts of EPA and DHA (as well as other omega 3 fatty acids) on the label.  You may find other ingredients listed.  Here are some more common ones and what they mean (and if you should avoid them):

1. d-Alpha Tocopherol: this is one of eight forms that make up Vitamin E.  This is fine.  One problem I do have is that many of the fish oils use vitamin E derived from soybean oil.  Soybeans are one of the most over-hyped ‘health foods’ of all time.  But, because it’s such a small amount, don’t worry about it.
2. Rosemary extract: this is fine.
3. Avoid products that contain gluten, milk derivatives, artificial colors or flavors.
4. Lemon flavor: to minimize fish taste.  This is fine.