US Omega-3 sales reached $600 in 2007 -- how far can the Omega 5 oil sales go?

Fish-Oil Doses Can Be Hard To Swallow

By DAVID STIPP

It's no wonder that more Americans are gulping fish oil. Hardly a month goes by without a study suggesting that the omega-3 fatty acids in fish oil can fend off disease -- including heart attacks, strokes, Alzheimer's disease, depression, rheumatoid arthritis, asthma, psoriasis and even attention-deficit hyperactivity disorder.

The problem is, to get the health benefits seen in clinical trials, you probably need to take fistfuls of capsules.

"The kind of benefits seen in most of the clinical trials with omega-3 generally have involved much higher doses than you see recommended on supplement labels," says Charles Serhan, a Harvard Medical School expert on omega-3's activity. "But although a large number of studies have used industrial-level doses," he adds, "we don't have rigorous scientific evidence about what the doses should be."

Regardless of the recommended dose, the need to stockpile bottles of supplements may diminish as more foods are fortified with omega-3 and as research shows ways of enhancing the benefits with other therapies.

While most of the scientific data on the health effects of fish oil aren't definitive, the federal National Institutes of Health concluded after a massive review three years ago that consuming omega-3 fatty acids cuts the risk of death from heart attacks and other cardiovascular causes, can reduce the joint pain of rheumatoid arthritis and "appears" important for proper brain development and function.

Because of news like that, the market for fish-oil supplements is booming. U.S. omega-3 supplement sales reached an estimated $600 million last year, up 20% from a year earlier, says the Global Organization for EPA and DHA Omega-3s, a Salt Lake City trade group. (The two key omega-3 fatty acids are called EPA and DHA.) Omega-3 fatty acids now rank as the fifth-best-selling dietary supplement, behind multivitamins, calcium and vitamins C and E.

In trials aimed at lowering high blood levels of triglycerides, a contributor to heart disease, patients took four particularly potent capsules that contained a total of more than three grams of EPA and DHA a day. You would have to pop a daily dozen of the typical omega-3 capsules on the market to get that much -- four to six times the suggested daily "serving" usually specified on their labels. That many capsules could cost you more than $2 a day, and it is a lot more than you are likely to get from consuming fish: You would need more than six servings a day of tuna, or about three of salmon, to get that much EPA and DHA.


Clinical trials suggest that fish oil can fend off a variety of ailments, but the omega-3 doses used in the studies have varied widely.

• Heart disease: one gram or more
• Rheumatoid arthritis: two grams or more
• Brain health: one-half gram or more

Fish may good for you, but you can get risky doses of mercury and other toxins by consuming lots of it. That is one reason the American Heart Association recommends that people who need to lower triglycerides to ward off heart attacks take omega-3 capsules. The suggested dose is two to four grams of EPA and DHA a day, which supplements can provide toxin-free. For healthy adults seeking merely to cut cardiac risks, the heart association says eating fatty fish, such as salmon, at least twice a week is probably enough.

But how much omega-3 should you take if you are trying to ease the joint inflammation of rheumatoid arthritis? Or ward off Alzheimer's disease? Or alleviate depression?

Unfortunately, there aren't enough clinical data to give firm answers. But the omega-3 literature affords hints. Results in various rheumatoid-arthritis trials indicate that you need to take more than two grams, perhaps 10 typical capsules, of omega-3 fatty acids a day to significantly curtail joint inflammation and pain.

For maintaining brain health, the overall data on omega-3's potential are inconclusive, according to the NIH. But a recent Dutch study showed that about 400 milligrams of EPA and DHA a day -- which you can get from two typical omega-3 capsules -- helped elderly men maintain mental acuity. The study found that the more omega-3 ingested, the greater the benefit.

In the depression data, two things stand out: EPA appears more effective than DHA. And about one gram of EPA seems optimal -- more isn't better.

All this suggests that you may have to take a half dozen or more typical omega-3 pills a day to get the kind of benefits observed in clinical trials with fish oil. But soon it may get easier to get such hefty doses without taking so many pills. A growing number of foods are fortified with omega-3, everything from yogurt to orange juice, including more than 1,200 such products launched in 2006 alone, according to the London-based market researcher Datamonitor. Such foods typically don't contain much omega-3 -- a fortified egg might contain half as much as a typical capsule. But as more fortified foods come to market, it will be easier to get omega-3 in your diet.

There is another reason popping fish-oil capsules by the fistful may be overkill. Many scientists believe omega-3's benefits flow primarily from its ability to damp low-level inflammation, which is thought to be a key culprit in just about every major scourge of aging, from clogged arteries to Alzheimer's. Studies over the past few years suggest that taking small doses of aspirin daily, which many people do to prevent heart attacks, magnifies the anti-inflammatory effect of taking fish oil.

Indeed, some of the most dramatic evidence of fish oil's heart benefits came from a 1999 Italian study in which patients who had recently had heart attacks showed a 45% reduction in subsequent "sudden cardiac death" when given modest fish-oil doses (the amount in about three typical omega-3 capsules). The supplements' striking effectiveness may well have been magnified by the fact that many of the patients were also taking aspirin daily.

Aspirin's effect on omega-3 isn't clear yet, though. So for now, big doses of the supplement probably are necessary to get the health benefits.

Omega-3 appears to be safe, even at the high doses used in clinical trials. But large doses can have side effects. Perhaps the best source on that issue is the prescribing information for Lovaza. Sold by GlaxoSmithKline PLC unit Reliant Pharmaceuticals Inc., Lovaza is prescribed for "very high" triglycerides.

In Lovaza's clinical trials, patients took four capsules a day with a total of 3.4 grams of EPA and DHA. The most common "adverse event," reported by about 5% of patients, was belching. Some 4% reported infections, compared with 2% on a placebo, but it's not clear whether fish oil caused the difference. While some research suggests that taking fish oil prolongs bleeding time, no bleeding problems were reported in the Lovaza trials.

There's no evidence Lovaza works better or is purer than high-end omega-3 dietary supplements -- such as those made by Nordic Naturals Inc., of Watsonville, Calif. -- which cost less than half as much as Lovaza does per gram of EPA and DHA.

A 2004 analysis of 44 kinds of omega-3 supplements by ConsumerLab.com1, based in Scarsdale, N.Y., found that none had unsafe levels of mercury or PCBs. And Lovaza wasn't used in most of the promising clinical trials with omega-3.