Is there an optimal arthritis fish oil dosage? Ever since researchers noted that native eskimos were quite stout and yet didn’t have many of the chronic diseases of industrialized society, fish oil has been in the research pipeline. The results of 20 years of publications, on balance, point to fish oil having big health benefits (helping with everything from cardiac disease to knee arthritis). However, for years I’ve told most of my patients that while they think they have this base covered, the junk they’re buying at the grocery store isn’t helping. Now a new study highlights that fact.
First, a fish oil primer. Fish oil contains important omega 3 fatty acids that come in two main forms, DHA and EPA. EPA is generally the form most researchers believe is helpful for arthritis. Second, the Eskimos eat a lot of fish oil, way more than you could ever get from that cheap bottle at CostCo. They eat loads of fish and then garnish their fish with fish oil, like you and I might add salt. So to really consume the same amount without popping 30-50 pills a day, you have to concentrate the oil. However, the concentration process screws up the natural triglyceride form of the fish oil, changing it so it no longer has the same health benefits. As a result, the high end manufacturers will add a natural enzyme to change it back to that triglyceride form after concentration (a one month supply is in the $35-55 range). Last, fish oil rapidly oxidizes, so if yours smells like fisherman’s warf, it’s not good. Again, high end manufacturers end up adding a natural acid like lemon to prevent this breakdown.
So why can’t you just go to the grocery store and buy the biggest and cheapest bottle you can find? The new randomized clinical trial looked at this issue by testing four types. The expensive stuff (concentrated fish oil where the triglyceride form was preserved-ConTri), cheaper concentrated fish oil (known as the EE form where the triglyceride form had not been preserved), cheap krill oil, and unconcentrated salmon oil. The 35 patients in the study consumed one type randomly for a month and then switched to the next until they rotated through all four (after a one month wash out). The researchers then measured blood samples after each month.
What happened? The only supplement that worked well to clean up the cardiac risk lab work was the expensive stuff. This was the concentrated triglyceride form fish oil (EPA of 650 mg, DHA of 450 mg). The other supplements had much less effect. As an example of bioavalability, the increase in omega-3 levels in the serum were ranked ConTri>EE>Salmon>Krill. In fact, the expensive stuff had four times the blood levels of omega 3s compared to krill and unconcentrated salmon oil.
The upshot? You get what you pay for. On a serum blood level basis, while good concentrated triglyceride form fish oil is about four times as much as the CostCo 1 year supply bottle, it provides four times the kick. As I’ve written before, krill oil isn’t your best bet, despite being cheap. Concentrated cheaper oils that are in the EE form are also not good. Finally unconcentrated salmon oil also can’t get the job done. So throw out that CostCo tub and get fish oil that is:
1. Concentrated so that it has at least an EPA of 650 mg, DHA of 450 mg
2. Has been converted back to it’s triglyceride form after concentration