DOWNRIVER CARDIOLOGY CONSULTANTS, P.C.
PATIENT INFORMATION : FISH AND FISH OIL
What about fish oil?
Scientists have known for over 30 years that fish and fish oils have some type of protective benefit for heart disease. The Eskimos in Greenland have had a very low incidence of heart disease in spite of eating a high-fat diet. It was shown that this is due to the protective effect of eating fatty fish. In particular, the benefit of fish is found in a component of fish oil called omega-3 fatty acids. These fatty acids are
“essential” for the normal function of the body and can only be obtained from dietary sources.
What are omega-3 fatty acids?
Omega-3 fatty acids consist of both EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). The combination of EPA and DHA is known to reduce inflammation and clotting which are both felt to play a role in the development of atherosclerosis (hardening of the arteries). Omega-3 fatty acids can be obtained through your diet or by taking supplemental gelatin capsules high in omega-3 fatty acids.
What are the benefits of fish oil?

After a heart attack, fish oils reduce the death rate from heart or artery disease by approximately
30%

Lowers one of the body’s fats called triglycerides by 30-40%


Allows modest reduction in the amount of medication utilized to treat rheumatoid arthritis
Can prolong pregnancy and prevent premature labor.

In infants, fish oils provide a temporary benefit in vision studies and neurologic function
Measurement of omega-3 fatty acids
The recommended dose of fatty acids is the sum (total) of DHA and EPA. This is usually measured in milligrams (mg). The ratio of DHA to EPA is not important.
If a fish oil capsule is utilized and it contains 200 mg of EPA and 120 mg of DHA, then the total dose of omega-3 fatty acids is 320 mg per capsule.
If you have been advised to consume 1000 mg (1 gram) of omega-3 fatty acids each day, you would need three capsules of the above fish oil:
320 mg x three = 960 mg (approximately 1 gram) of omega-3 fatty acids
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Recommendations for fish oil
Patients:
Without documented coronary heart disease
Eat a variety of fish (fatty) at least twice a week.
Include oils and food rich in alpha linolenic acid (flax seed, canola and soy bean oils; and walnuts)
With documented heart disease
Consume approximately 1 gram of EPA plus DHA per day, preferably from fatty fish
EPA plus DHA supplements (fish oil capsules) could be considered in consultation with your physician
Consume 3-4 grams of EPA plus DHA per day, provided as fish oil capsules Who need to lower triglycerides
With rheumatoid arthritis
Consume 3-6 grams of fish oil per day
Infants (not breastfeeding)
Women who are pregnant or of child-bearing age
Consider omega-3 and omega-6 enriched infant formula
Consume two fatty fish meals per week
Avoid fish high in mercury
Warning: The use of three or more grams of fish oil per day may cause increased bleeding. Notify your physician if you use these higher doses.
For more information please see: www.americanheart.org/presenter.html?identifier=4632
Fatty fish or fish high in omega-3 fatty acids:
Herring Mackerel
Salmon Tuna
Lake trout
Halibut
Mercury concerns:
Mercury has been known to cause certain cancers and nerve disorders. Mercury can be found in fish as a result of water pollution. Because of this, the FDA and EPA have an advisory on fish intake. Pregnant women, women planning to conceive, nursing mothers and children should avoid eating fish high in mercury. These women should still eat two meals a week of low-mercury fish. For men, the benefits of fish and fish oil outweigh the risk of mercury. However it is still wise to avoid those fish that are high in mercury.
High-mercury fish:
Shark
King Mackerel
Swordfish
Tilefish
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FISH OIL CAPSULES
There are many fish oil products on the market and the choice for the correct one is difficult. There is only one product approved by the FDA and that is Omacor. This requires a prescription. Many of the over-the-counter preparations are safe. It is best though if they are branded as USP-verified (United States
Pharmacopeia verified). Be aware that the suggested daily dose on the label may not equal the dose recommended for the prevention of heart disease (1 gram) or the treatment of high triglycerides
(3 grams). Try to calculate the cost of obtaining 1000 mg (1 gram) of EPA plus DHA per day or per month. This will help you in choosing the right product. The ratio of the EPA to DHA is not important. It is the total that you need to obtain. To complicate matters further, the label may describe a large amount of fish oil concentrate. However you need to read the back label that describes how much EPA and DHA are included in the gelcap. Also remember that the recommended daily dose on the bottle may not be the recommended daily dose that you wish to obtain. The higher quality or USP verified gelcaps do not have significant quantities of mercury that would be a concern.
Average cost of fish oil capsules
1 bottle = 175 softgel caps
1 serving = 2 soft gels
1 serving = 360 mg EPA + 240 mg DHA = 600 mg total
1 softgel = 600 mg ÷ 2 = 300 mg
300 mg x 3 = 900 mg
Dose for 900-1000 mg = 3 softgels per day
175 softgels per bottle ÷ 3 per day = 58 days
Price - $5.00 per bottle
$5.00 per bottle ÷ 58 = 9¢ per day
A good price, but it took more time than is easy to calculate at the checkout counter.
Here is what we have found based on pricing from two websites:
DHA+EPA per capsule
Cost per bottle
Brand Name www.drugstore.com
Twin Labs
Capsules per bottle
60
180 GNC
Nature Made
Rite Aid
Weil Omega
Omacor
(prescription)
100
175
60
30 www.costco.com
Pure Gel 200
840 mg
300 mg
324 mg
300 mg
500 mg
1000 mg
500 mg
$23.00
$10.50
$7.00
$5.00
$14.00
$39.00
$12.00
Capsules per day
1-1/2
3
3
3
2
1
2
Cost per day
51¢
17¢
21¢
9¢
48¢
$1.30
12¢
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Side effects of fish oil capsules
The most common side effect of the capsule is a “fishy taste”. This can be reduced by taking the gelcap with a meal. Also, try switching brands of fish oil. Some are less fishy-tasting than others. Omega-3 fatty acids may also increase bleeding time, cause minor increase in the LDL, and/or raise blood sugar in diabetics. Generally these side effects are a concern only when the dose is above 3 grams per day. It is usually felt that the benefits of fish oil outweigh the potential risks.
This website has more information: www.oceansalive.org/eat.cfm
Environmental concerns
Most of us are concerned about the possible chemicals that we may place in our body by eating fish. On the other hand, significant concerns relate to the human consumption of fish and the effects on the environment. It is anticipated that by the end of this century almost all the fish stocks will be depleted. In addition, most of the fish farming has not been developed in methods that can be continued in the long term. For further information on fish products that are safe for us and safe for the environment see www.montereybayaquarium.org/cr/seafoodwatch.asp
. There you can print out a pocket guide to seafood that can help you choose the best fish when you are shopping or eating out.
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