Can I Take Omega-3 Supplements Instead of Eating Fish?

You've probably heard that omega-3 fatty acids are good for you, and are one of the reasons many people are adding more fish to their diets. But many people do not like to eat fish, or at least that often. Can you get the same omega-3s by taking a supplement instead?

Omega-3 Fatty Acids: Why All the Hype?

Omega-3 fatty acids are a type of polyunsaturated fat (or oil) and are essential for nervous system function as well as many other body systems.

Omega-3s may be good for dry skin and eyes and are definitely good for your heart due to both their ability to reduce blood pressure and decrease the risk of sudden death. Unlike omega-6 fatty acids, they do not promote atherosclerosis, the underlying problem with cardiac diseases such as coronary artery disease.

Omega-3 fatty acids can have a very positive effect on triglyceride levels and is the indication for three prescription supplements of omega-3s. While DHA and EPA can reduce triglyceride levels, however, especially in people who have very high triglyceride levels, the effect may not be all positive. In high doses, omega-3s may decrease the size of LDL cholesterol and reduce HDL (good) cholesterol. Prescription omega-3 supplements are recommended only for people with high triglyceride levels. Learn more about the effect of omega-3s on cholesterol and triglycerides.

In light of these potential health benefits, many people turn to the leading source of omega-3s: fish.

But what if you don't like to eat fish or at least that much fish? Fortunately, there are alternatives that don't swim in the sea including plant-based sources and omega-3 supplements.

To understand the best sources of omega-3 fatty acids, and to choose the best supplement, it's helpful to understand the different types of omega-3s.

Types of Omega-3 Fatty Acids

There are actually several different types of omega-3 fatty acids, and these types may vary in the impact they have on your health. Omega-3s include:

DHA (docosahexaenoic acid)
EPA (eicosapentaenoic acid)
ALA (alpha linolenic acid)

Sources of Omega-3 Fatty Acids

There are three primary ways to add more omega-3s to your diet: fish, plants, and supplements. Let's take a look at each of these separately and then answer the question on whether supplements can be used to replace fish.

Fish and Omega-3s

Overall, fish are the top source of the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These are the forms of omega-3 fatty acids that your body needs, and why the American Heart Association recommends eating at least two servings of fish each week. The top fish for omega-3 fatty acids include fatty fish such as salmon, tuna, anchovy, halibut, herring, mackerel, trout, and sardines.

Plant-Based Sources of Omega-3 Fatty Acids

One alternative to eating fish is to eat plants and oils containing omega-3 fatty acids. Unlike fish, plants provide alpha-linoleic acid (ALA) rather than DHA or EPA. That said, our bodies for the most part convert ALA to either DHA or EPA depending on which fatty acid your body needs.

The best plant sources of omega-3 fatty acids include:

Nuts including walnuts and almonds
Seeds such as flax seeds, chia seeds, pumpkin seeds, hemp seeds, and pine nuts
Edamame
Canola oil
Navy beans

It's easy to add plant sources of omega-3s to your diet, for example, you can add pumpkin seeds to a salad, cook with canola oil, and snack on walnuts. You can also buy milled flax seeds and take them by the spoonful, similar to taking a supplement.

If you need large doses of EPA or DHA and don't eat fish, it's likely that plant sources alone may not be enough. If that is the case, an omega-3 fatty acid supplement may be recommended.

Omega-3 Fatty Acid Supplements

Both fish oil and plant-based omega-3 fatty acid supplements are available and current research suggests that omega-3 supplements can offer much of the same benefits of fish.

Fish-based supplements may include fish oil, cod liver oil, or krill oil, and contain varying amounts of EPA and DHA. Plant-based supplements contain ALA, which is converted to EPA and/or DHA in the body.

Since nutritional supplements are not regulated to the same degree as prescription products, it's important to purchase a good product from a reputable source.

Prescription Omega-3 Fatty Acid Supplements

In addition to over-the-counter supplements, prescription supplements are available. Lovaza (omega-3 ethyl esters), Vascepa (icosapent ethyl), and Epanova are primarily used for people with very high triglycerides.

Side Effects and Safety of Omega-3 Fatty Acid Supplements

Omega-3 supplements are often safe, as long as you do not have a reason to avoid them (see below) and you follow the label directions. It's always a good idea to talk to your doctor about any nutritional supplements, especially if you have any chronic medical conditions. Dietary supplements can have side effects and interact with some medications. Both short term and long term side effects may occur and include:

Short-term side effects: Fishy burps. If you don't like fish, you'll probably really hate the 'fish burps' that these supplements can cause. So another option is algal oil, which is made from ocean algae. It's the only plant source that contains pre-formed DHA.

Long-term side effects: Taking these supplements for extended periods of time may lead to vitamin E deficiencies in some people, and taking large amounts of omega-3 supplements may interfere with blood clotting. So whether you decide to eat more fish or not, please speak with your healthcare provider before taking large amounts of omega-3 fatty acids or any other dietary supplements.

Drug interactions: Talk to your doctor about any medications you are taking, but fish oil is most likely to interact with diuretics, beta-blockers, and blood thinners.

Omega-3s, Fish, Supplements, and Mercury

In recent years there has been more concern about the mercury content of both fish and fish oil supplements. It's not possible to completely avoid mercury as there are small amounts of mercury in all fish, but you may wish to avoid higher mercury level fish especially if you are pregnant or breastfeeding. These are listed below under pregnancy.

Who Should Avoid Omega-3 Fatty Acid Supplements

It appears that omega-3 fatty acids may have some benefits, and can fill in the gap for those who don't eat large quantities of fish or nuts.

There are some people, however, who should not take these supplements. This includes:

People who are allergic to fish or shellfish
People who have liver disease or abnormal liver function tests
People with atrial fibrillation
People who are taking medications which could interact with omega-3 fatty acids such as some blood thinners (supplements could further increase the risk of bleeding), beta-blockers, or diuretics.

In addition, if your lipid profile is abnormal, your doctor may wish to monitor your LDL.

Pregnancy, Breastfeeding, and Omega-3 Fatty Acids

At first glance, many people would simply avoid omega-3 supplements if pregnant, but it is important to talk to your obstetrician both about eating fish and taking an omega-3 supplement if you don't. It's thought that pregnant women in the U.S. do not eat enough fish, and omega-3 fatty acids are important in the development of the growing baby's brain. The Environmental Protection Agency recommends that pregnant women consume 8 to 12 ounces of low-mercury fish each week. If you are pregnant and do not eat fish, talk to your obstetrician about the safest supplement to use.

Low mercury fish include canned light tuna, salmon, pollock, sardines, and anchovies.
High mercury level fish include mackerel, swordfish, albacore tuna, and tilefish.

Bottom Line on Getting Omega-3 Fatty Acids Without Eating Fish

Omega-3 fatty acids play an important role in the health of both your nervous system and heart. Ideally, it's recommended that people eat fish twice weekly to get an adequate amount of DHA and EPA. If you don't eat fish, plant sources are available which provide ALA, though this can be challenging. Omega-3 supplements can fill the gap in this case, though it's recommended that you talk to your physician before using any supplement. Choosing a high-quality supplement from a reputable source (you usually get what you pay for) is a good idea as nutritional supplements are not highly regulated in the U.S.

There certainly may be benefits to eating fish than are not present in a supplement, as other nutrients in fish may play a role in reducing cardiovascular disease. Yet for those who do not like fish, a supplement is often a reasonable alternative.

There are some short-term and long-term side effects of which you should be aware, and omega-3 supplements may also interact with some medications.

Source:

Balk, E., and A. Lichtenstein. Omega-3 Fatty Acids and Cardiovascular Disease: Summary of the 2016 Agency of Healthcare Research and Quality Evidence Review. Nutrients. 2017. 9(8):pii: E865.

National Center for Complementary and Integrative Health. Omega-3 Supplements: In Depth. Updated 08/15. https://nccih.nih.gov/health/omega3/introduction.htm