Fish Oil Supplements vs. Eating Fish: Debunking the Health Hype

Fish oil, renowned for its omega-3 fatty acids, has long been touted for its potential health benefits, including enhancing heart health, safeguarding against dementia, and alleviating the symptoms of arthritis. Yet, amidst the growing popularity of fish oil supplements, questions abound. Are these supplements as healthful as they are believed to be? Does consuming fish offer the same advantages as taking supplements?

To unravel these complexities, it is essential to delve into the nature of omega-3 fats, their roles in our health, and the scientific evidence underpinning their purported benefits. This exploration will shed light on the dichotomy between fish oil supplements and dietary sources, offering insights into their relative merits.

Understanding Omega-3 Fats

Omega-3 fatty acids constitute a subset of polyunsaturated fats that are deemed essential for our well-being. Unlike saturated fats, which our bodies can synthesize, we must obtain omega-3 fats from dietary sources because we lack the enzymatic machinery to create them endogenously.

In our diet, three principal types of omega-3 fats hold significance:

1. Alpha-linolenic acid (ALA): Predominantly found in plant-based foods like green leafy vegetables, flaxseed, chia seeds, and walnuts.

2. Eicosapentaenoic acid (EPA): Primarily sourced from seafood, eggs (particularly those from free-range hens), and breast milk.

3. Docosahexaenoic acid (DHA): Like EPA, DHA is chiefly found in seafood, eggs (again, in higher concentrations in free-range eggs), and breast milk.

Omega-3 fats play a pivotal role in our cellular structure, contributing to the functioning of vital organs such as the heart, lungs, blood vessels, and immune system.

Fish vs. Supplements: The Absorption Question

The genesis of the belief in the health benefits of omega-3 fats can be traced back to observational studies involving individuals who incorporated fish into their diets, not fish oil supplements.

A fundamental question arises: Are the "active ingredients" within supplements—the EPA and DHA—absorbed by our bodies in the same manner as those derived from fish?

A controlled intervention study, where one group received fish while another group was given fish oil supplements, yielded encouraging results. It showed that when comparable quantities of EPA and DHA were consumed, either from fish or supplements, the levels of these fatty acids in the body increased similarly.

However, this perspective assumes that the health benefits attributed to omega-3 fats solely hinge on these specific fatty acids. It overlooks the possibility that other constituents of fish, including proteins, vitamins (such as A and D), iodine, and selenium, might also contribute to—or even solely account for—the observed health benefits. Moreover, the absence of certain nutrients typically found in other meat sources, such as saturated fats and salt, may further bolster the perception of fish's healthfulness.

Examining the Evidence: Heart Health, Arthritis, and Dementia

To gauge the merits of omega-3 fats, it is essential to scrutinize the scientific evidence concerning their impact on three distinct health domains: heart disease, arthritis, and dementia.

Heart Disease:

A comprehensive meta-analysis, considered the gold standard for evidence synthesis, has suggested that fish oil supplementation may have little to no discernible effect on cardiovascular disease, including heart attacks and strokes. Alternatively, a different meta-analysis found that for every 20 grams of fish consumed daily, the risk of coronary heart disease was reduced by 4%. The National Heart Foundation advocates the consumption of omega-3-rich fish for optimal heart health. Fish varieties with a pronounced fishy taste, like tuna, salmon, deep-sea perch, trevally, mackerel, and snook, are especially recommended. While fish oil may hold potential benefits for individuals with heart failure or elevated triglyceride, a type of blood fat linked to heart disease and stroke, it is not endorsed as a preventive measure against cardiovascular diseases.

Arthritis:

Studies have demonstrated that fish oil supplements can indeed alleviate the severity and progression of rheumatoid arthritis. However, achieving the requisite levels of EPA and DHA from dietary sources alone is often impractical and costly due to the substantial quantities needed. Arthritis Australia suggests a daily intake of about 2.7 grams of EPA and DHA to mitigate joint inflammation. Most supplements typically contain 300-400mg of omega-3 fats. Depending on the concentration of EPA and DHA in each capsule, individuals may need to consume nine to fourteen capsules per day or five to seven capsules of fish oil concentrate, which is equivalent to approximately 130g-140g of grilled salmon or mackerel or 350g of canned tuna in brine (roughly four small tins).

Dementia:

Epidemiological studies have uncovered a positive association between heightened DHA intake through dietary sources and a reduced risk of Alzheimer's disease, a form of dementia. Animal research has indicated that DHA can influence markers associated with brain function, including the accumulation of amyloid, a protein linked to dementia, and damage to tau protein, which stabilizes nerve cells in the brain. However, these findings have not yet been replicated in human studies. Systematic reviews have yielded mixed results concerning the effects of omega-3 fats from supplements. While two studies administering omega-3 fats as supplements to individuals with dementia showed no improvements, there was notable improvement when given to individuals with mild cognitive impairment, a condition associated with a heightened risk of dementia.

Additionally, a meta-analysis revealed that a higher consumption of fish was correlated with a lower risk of Alzheimer's disease, whereas no such association was found with the total dietary intake of omega-3 fats. This implies that other protective factors might be inherent to fish consumption. In light of this evidence, the Alzheimer's Society recommends opting for dietary sources of omega-3 fats over fish oil supplements.

The Verdict: A Holistic Approach to Health

The key takeaway from this comprehensive evaluation is that adhering to a wholesome, plant-based diet with a regular inclusion of fish, while minimizing the consumption of ultra-processed foods, can significantly enhance overall health.

Presently, the evidence leans in favour of fish oil for individuals grappling with rheumatoid arthritis, especially those unable to attain sufficient levels of EPA and DHA through dietary means alone.

In the context of dementia and heart disease, the best course of action is to prioritize the acquisition of omega-3 fats from dietary sources. While plant-based foods contain ALA, which offers health benefits, it may not be as effective as augmenting EPA and DHA levels through seafood consumption.

For those considering fish oil supplements, it is prudent to inspect the product's use-by date and ensure its timely consumption. The chemical structure of EPA and DHA renders them susceptible to degradation, which can compromise their nutritional value. Storage in cool conditions, preferably within a refrigerator and away from direct light, is recommended.

Furthermore, individuals should engage in open discussions with their healthcare providers, particularly if they are concurrently using other medications. This collaborative approach ensures a well-informed decision regarding the incorporation of fish oil into one's health regimen.

In the pursuit of optimal well-being, the emphasis should remain on a holistic approach to nutrition and health—one that incorporates a diverse array of nutrient-rich foods while maintaining a balanced and varied diet.