Omega-3 Fatty Acids (Fish Oil): EPA, DHA, and How Much is Enough?

We've discussed what omega-3 fatty acids are, and how essential they are for our general health (Brain Health: Omega-3 Fatty Acids (Fish Oil)). In order to choose an omega-3 fatty acids (fish oil) supplement, it is helpful to understand what two of the essential fats, EPA and DHA, are.

There are so many of these fish oils supplements on the market, each touting its own ratio of DHA to EPA as "best". It may be more of a matter of "best" for "what?".

The ratio of these fats chosen may depend on which body systems one may affect more than the other. The supplement you may choose, and the amount given, may vary for a person with arthritis, diabetes or cardiovascular disease as opposed to a person with bipolar still cycling while on lithium, or a child in danger of having symptoms escalate into childhood-onset schizophrenia, or person already deep in the throes of psychosis.

Both DHA and EPA, along with some other essential fats (including GLA), are critical to our general health and well-being. There is substantial evidence that together they fight inflammation, and may be effective either alone or as adjunct therapy in fighting and preventing depression, mood swings, arthritis, asthma, cognitive decline, cardiovascular disease, diabetes, aggressive behavior, attentional difficulties and schizophrenia. It is also essential for pregnant and nursing mothers to ensure adequate brain, neurological, and visual development in their babies.

Different studies have found DHA and EPA to be more or less important for various functions.

• Some have found DHA to be more important in fighting inflammation and staving off conditions from gum disease to post-traumatic stress disorder, insomnia, Alzheimer's, and strokes, as well as growing and re-growing BRAIN matter.

• Other studies have found EPA to be the critical factor in helping decrease symptoms of bipolar disorder, depression and schizophrenia or schizoaffective.

At a medical conference on brains,  one doctor/researcher commented that for some individuals it is not just the EPA and DHA that is needed, but also another essential fatty acid, Gamma-linolenic acid (GLA), which is an omega-6 fatty acid that is found mostly in plant based oils such as borrage seed oil, evening primrose oil, and black currant seed oil.

Another tidbit presented is that too much EPA can decrease the usage of our DHA, and DHA is critical! Children especially, NEED DHA! It is what is needed to grow their brain.

Along with omega-3 fatty acids, omega-6 fatty acids play a crucial role in brain function, as well as normal growth and development. Also known as polyunsaturated fatty acids (PUFAs), they help stimulate skin and hair growth, maintain bone health, regulate metabolism, and maintain the reproductive system.

At the conference, a ratio of EPA:DHA:GLA recommended was 4:3:2.  A product with such a ratio, highly recommended by our own doctor for some patients with illness (this was not about "mental" illness) is: Beyond Essential Fats by Natura Health Products.

The product which has been FDA approved for lowering cardiovascular risk (lowering the bad fats (triglycerides) in our blood vessels), Lovaza, uses an EPA:DHA ratio of approximately 1.6 to 1.25.

Many of the recent clinical studies for psychiatric purposes have concentrated on EPA finding that most effective for "psychiatric" disorders. Indeed, the product that has been through vigorous double-blind, placebo controlled clinical studies for symptoms of the brain such as depression, bipolar and psychotic disorders, OmegaBrite, uses a 7:1 EPA to DHA ratio. When 1 Gram (1000 mg) of "fish oil" is referred to, that translates into 1 Gram of EPA. 

On the other hand, some studies showed that DHA squelched the tendency of children to have an increase in anger, hostility, and aggression while experiencing chronic stress such as during weeks of exams at school.

Some pure, high quality supplements, such as Omega-Smooth for children by Ascenta Health and Super Omega-3 by LEF, touted for general health, brain health and a host of inflammatory processes, have quite similar EPA:DHA ratios of 3:2 and 7:5 respectively.

Many doctors are now saying that although the brands like OmegaBrite which is high in EPA may be good for initial onset of depressive or schizophrenic symptoms, that may not be best for long-term use. For  the long-term use, a person may need higher levels of DHA, or perhaps even DHA alone.


Additionally, doctors have suggested that fish oil should be taken along with antioxidants such as vitamins E and C. Many formulations now include some antioxidants in them. If not, it may behoove us to take antioxidant supplements along with the fish oil supplements. It is also important to choose highly refined, pharmaceutical grade fish oils that have heavy metals such as mercury and other toxins such as PCBs, removed from the fish oil.

It should be emphasized that general health and reduction of inflammation in general, is important to overall brain health. Omega-3 fatty acids may help reduce inflammation. Inflammation and elevated inflammatory cytokine levels have been strongly linked to depression, fatigue, cardiovascular risk, autoimmune illnesses, and more, and can be increased by a deficiency in omega-3 fatty acids. Some studies suggest that some of the antidepressants may act as anti-inflammatory agents.

A frequent question people have is whether omega-3 fatty acids from non-fish sources work as well. The answer, so far, unfortunately is "probably not," although I have also read from the doctors who believe there are specific "metabolic types" (see books below) that vegetarian "types" are more efficient at converting the shorter-chained vegetarian sources into what we need.

There are several types of essential fats we require which we can get from multiple sources-- both animal and vegetable. Unfortunately, for the effects in these studies, concentrated fats from vegetarian sources have not been equivalent. There is some evidence that flaxseed oil may may trigger mania in some children with bipolar tendencies.

So far, research only favors fish oil as having all these therapeutic effects. That said, if a person for personal reasons does not eat animal products, by all means, getting the essential fatty acids as best as they can from non-animal sources is preferable to not getting them at all.

Good vegetarian / vegan sources of the shorter chained omega-3s (which are building blocks for the longer chained ones) include Flax seed. There is also Salvia Hispanica (also called Chia seed or Salba). Research is showing this may be better than the flax.

How much is enough?  In general, the research has been using about 300-1,000 mg (1 Gram) of "fish oil" to maintain health in already healthy individuals, and 2-4 Grams "fish oil" in adults with mood and psychotic disorders. Many of the studies done on children, which showed the efficacy of fish oil in maintaining mood and preventing predisposed children from having symptoms further deteriorate, used 1.5 Grams (some have used over 3 Grams, but 1.5 Grams of "fish oil" has been shown to prevent many of the deteriorating psychiatric conditions in youth).


It should be noted that fish oil supplements may be contraindicated in people with certain conditions, and/or on certain medications such as blood thinners (such as Coumadin or Warfarin). Always consult with a medical professional before implementing dietary changes, including adding or discontinuing food supplements.

Next, we'll discuss some choices of fish oil supplements that parents have especially liked: (Fish Oil: Costs and Favorite Brands)

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Other Related Topics:

• Inflammation of Body and Brain
• Nutrition, genes, and brain dysfunctions: Folate
• Stress and Our Children. How Much is Too Much?
• Important Links to Help Our Children

Books:

• The Metabolic Typing Diet: Customize Your Diet to Your Own Unique Body Chemistry
• The Omega-3 Connection: The Groundbreaking Antidepression Diet and Brain Program
• It's not mental: finding innovative support and medical treatment for a child diagnosed with a severe mental illness

References:

• Anti-stress effects of DHA.
• Hamazaki T, Itomura M, Sawazaki S, Nagao Y Biofactors. 2000; 13(1-4): 41-5
• The effect of fish oil on physical aggression in schoolchildren--a randomized, double-blind, placebo-controlled trial. Itomura et. al. J Nutr Biochem. 2005 Mar ; 16(3): 163-71
• Administration of docosahexaenoic acid influences behavior and plasma catecholamine levels at times of psychological stress.
  Hamazaki T, Sawazaki S, Nagasawa T, Nagao Y, Kanagawa Y, Yazawa K Lipids. 1999; 34 Suppl: S33-7
• Fighting Depression and Improving Cognition with Omega-3 Fatty Acids By Laurie Barclay, MD Life Extension Magazine Oct 2007.
• Fish oil showing promise in kids' brain disorders Chicago Tribune June 2007
• Omega-3 levels in orbitofrontal cortex linked to schizophrenia (Schizophr Res 2007; 91: 37–50)
• OMEGA-3 SAFE AND EFFECTIVE IN PEDIATRIC BIPOLAR DISORDER
• Fish oil could keep schizophrenia at bay Australian Herald Sun Newspaper 29 Nov 2007
• IL-6 levels decrease with SSRI treatment in patients with major depression. Basterzi AD, Aydemir C, Kisa C, Aksaray S, Tuzer V, Yazici K, Göka E Human Psychopharmacology. 2005 Oct ; 20(7): 473-6
• Antidepressant therapy and C-reactive protein levels. O'Brien SM, Scott LV, Dinan TG Br J Psychiatry. 2006 May ; 188: 449-52

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Last Updated: 09 December 2011