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The Dangers of Polysupplementation: Fish Oil

Fish oil is one of the darlings in the world of supplementals. If you are reading this post, there is a huge possibility that you currently take or have taken fish oil supplements. But, the reality is that just like polypharmacy can cause undesirable effects, so can polysupplementation.

We have talked about the most misunderstood supplement, Iodine (1) (2), and the dangers of B vitamins in previous articles. Today we are going to dig deep into another overutilized nutrient: Fish Oil, and why the old saying “let thy food be thy medicine” might just be truer than ever.

The History of Fish Oil

The idea of using fish oil for heart health started when scientists observed that Inuit peoples had lower rates of heart disease. Inuit populations eat large amounts of seafood, and in turn, fish contains large amounts of omega-3 fatty acids (mainly DHA and EPA)1.

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DHA and EPA are really important, as they are building blocks of the cell membrane. Omega-3 fatty acids help cells become more “elastic” and thus help cells in your body move about more freely. This helps the cells become more resilient and prevents future damage2.

Both DHA and EPA are also anti-inflammatory fatty acids. Any time there is damage to the cell membrane, and these fatty acids are broken down into metabolites, they aid in cases of inflammation. For example, one of the metabolites from omega-3’s is aptly named resolvin and it actually resolves the inflammatory response and promotes healing3.

Key Insight: Because omega-3 fatty acids are found in fatty fish, scientists developed refined fish oils that contain high levels of DHA and EPA in order to boost your levels of these compounds in your cells. The thought here might be “Awesome! Scientists solved heart disease!” Well, you know that is not the case.

I really wish the story ended there, but as you know, incidences of heart disease continue to rise. In fact, after scientists went back and re-analyzed the data, it turns out that we jumped to conclusions.

When the data was re-examined, scientists found that the incidence of strokes in Alaskan, Northern Canadian, and Greenland natives was actually higher than in Western populations4!

Bottom Line: Because of research on Inuit groups, refined fish oils were thought to have the ability to reduce cardiac events. This is where the concept of fish oil all began.

What Science Says About Fish Oil

Within the health space, fish oil is touted as something of a “super supplement.” The benefits attributed to fish oil range from:

  • Helping with sugar control
  • Lowering inflammation
  • Lowering heart disease

Unfortunately, the data on all these claims is mixed. Let’s perform a deep dive into each so that you can learn a little bit more:

Heart Disease

A study from Siscovick and Friends found that an increase in omega-3 consumption decreased the risk of heart attacks. The caveat is that the study focused on omega-3 fatty acids coming from whole foods, specifically fish. In fact, when investigators performed a meta-analysis of the data involving omega-3 fatty acid supplementation, the results were rendered inconclusive5.

Metabolic Syndrome

Another use for fish oil is to modify the cholesterol profile of patients. Some studies have been positive, for example, in a study where fish oil was combined with olive oil demonstrated that the combination has a beneficial and synergistic effect in the lipid profile of patients6.

Key Insight: On the other hand, fish oil alone does not. Two studies one using 3 grams of fish oil per day, and the other one using 5 grams of fish oil per day showed negative effects.

The first study involved women with metabolic syndrome. They were given either:

  • Toasted soybeans
  • 3 grams of fish oil
  • A combination of each

The study found that the fish oil alone lowered triglycerides, but it also elevated the undesirable cholesterol LDL7.

The other study followed men with insulin resistance. The experiment was peculiar; because the subjects were given either 5 grams fish and krill oil or canola oil (used as a control). The subjects that received the combination of fish oil and krill oil actually had an increase in their insulin resistance in comparison to the control group8.

Cardiovascular Death

Finally, a double-blind placebo-controlled trial that was able to enroll over 12,500 subjects with dysglycemia (poor glucose control) found that supplementation with 1 gram of omega three fatty acids did not provide a benefit over placebo.

The conclusion of the paper states that “Daily supplementation with 1 g of omega-3 fatty acids did not reduce the rate of cardiovascular events in patients at high risk for cardiovascular events9.”

You might find yourself scratching your head. Why is there so much confusion about the benefits of omega-3 fatty acids? In the next section, we will discuss how this all makes sense.

Oxidation and Health

Our cells are constantly fighting a war against oxidation. Oxidation happens when oxygen atoms interact with different molecules in the body and degrade them. Our cells have many mechanisms to prevent this type of decay, but when nutrients become oxidized instead of providing essential functions within the cell, they become damaging.

Key Insight: One of the theories behind the ill effects of highly purified omega-3 fatty acids is that these fatty acids are really fragile. In fact, scientists continually study ways of making ALA, DHA and EPA (the main omega-3 fatty acids) less prone to oxidation.

When these fatty acids oxidize, they become rancid, and their beneficial effects are lost. Have you ever taken fish oil and had “fish burps”? It is likely that the fishy burps are caused by rancid fish oil! Rancid fish oil actually causes damage to the cells, negating the possible benefits of such fatty acids10.

Which bring us back to an explanation of why some studies show positive outcomes.

First, why would a combination of olive oil and fish oil be beneficial versus fish oil alone? Olive oil is a more stable fatty acid and thus it might help protect the fish oil from becoming rancid. Therefore, the combination of fish oil and olive oil had beneficial health effects in comparison to fish oil alone6.

The second study I want to highlight is the one comparing fish oil to canola oil. If you recall, in that study there was no difference between canola oil (the control) and fish oil. This is because canola oil is usually combined with vitamin E, a powerful antioxidant which helps it become more stable.

When compared to the very unstable fish oil, it makes sense that both were comparable in their effects towards health9. For more information about canola oil, you should definitely read this article by Dr. C (3).

The third study mentioned above is actually supporting the use of kinako (toasted soybeans) as a synergistic antioxidant to prevent the oxidation of fish oil. The results showed that this addition actually helped improve the stability of fish oil and thus its anti-inflammatory properties7.

Finally, the human body is not very efficient at processing omega 3 fatty acids. There are physiological stop gaps that prevent the human body from assimilating some of these fatty acids into our cells.

For example, only 5% of ALA (a precursor of DHA and EPA) can only be absorbed by the human body11! The rest ends up becoming rancid. For this reason, it is very important to consume preformed DHA and EPA12.

Bottom Line: I can only imagine that high doses of purified fish oil end up in the same way. Think about it, nowhere in the natural world would we find 5 grams of encapsulated fish oil. Our bodies are just not used to this massive dose.

Omega-3 Fatty Acids for Health

As you can see, health is more complicated than just taking another supplement. Fortunately, we have some recommendations to make it easier for you to achieve your perfect state of health.

First, it is undeniable that omega-3 fatty acids are beneficial for your health. But, instead of relying on supplements, you should get your omega-3s from food.

Aim to consume two to three servings of fish per week. This constant low dose of omega-3 fatty acids is easily incorporated into your body, unlike high dose supplementation. The proteins from the fish will help the fatty acids become more stable and your body will be able to utilize them.

Key Insight: Do not take high doses of omega-3 fatty acids. High doses will likely end up becoming oxidized, at a minimum you will get fishy burps, at worse they could be creating oxidative damage at the cellular level.

If you don’t eat two to three servings of fish per week, or if your practitioner deems it necessary for you to supplement with omega-3 fatty acids, you should take precautions on how to take them. Instead of taking one big dose, aim to take your omega-3’s in two or three doses. Take your supplemental omega-3 with food, especially with food high in antioxidants such as olive oil.

Keep your fish oil in a dark container in a cool place to prevent oxidation. More importantly, get a high-quality omega-3. This is one supplement where you should spare no expense.

The Risks of Polysupplementation

Supplementation can be very tricky, even the most popular supplements have a dark side. There is no doubt that Omega-3 fatty acids are beneficial for your health, but high-dose supplementation is not the answer. Aim to obtain your nutrients from your diet, if your practitioner deems it necessary for you to supplement, do it smartly.

For example, our Daily Reset Packs are crafted to include omega-3 fatty acids in the same pack as your antioxidant supplements. This, in turn, protects the omega-3 fatty acids from oxidation when you take them!

We also recommend to take your Daily Reset Packs with a meal and we even designed the dosing to be divided, to help with absorption. By following our simple recommendations, you will be able to make the most of your supplements and help you in your way to achieve perfect health.

Daily Reset Packs - Complete Nutrition - Dr. Alan Christianson

1. Dyerberg J, Bang HO, Hjørne N. Fatty acid composition of the plasma lipids in Greenland Eskimos. Am J Clin Nutr. 1975;28(9):958-966. doi:10.1093/ajcn/28.9.958.
2. Swanson D, Block R, Mousa SA. Omega-3 Fatty Acids EPA and DHA: Health Benefits Throughout Life. Adv Nutr. 2012;3(1):1-7. doi:10.3945/an.111.000893.
3. Obrosov A, Coppey LJ, Shevalye H, Yorek MA. Effect of Fish oil Vs. Resolvin D1, E1, Methyl Esters of Resolvins D1 or D2 on Diabetic Peripheral Neuropathy. J Neurol Neurophysiol. 2017;08(06). doi:10.4172/2155-9562.1000453.
4. Bjerregaard P, Kue Young T, Hegele RA. Low incidence of cardiovascular disease among the Inuit—what is the evidence? Atherosclerosis. 2003;166(2):351-357. doi:10.1016/S0021-9150(02)00364-7.
5. Siscovick DS, Raghunathan TE, King I, et al. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA. 1995;274(17):1363-1367. http://www.ncbi.nlm.nih.gov/pubmed/7563561. Accessed August 2, 2018.
6. Venturini D, Simão ANC, Urbano MR, Dichi I. Effects of extra virgin olive oil and fish oil on lipid profile and oxidative stress in patients with metabolic syndrome. Nutrition. 2015;31(6):834-840. doi:10.1016/j.nut.2014.12.016.
7. Simão ANC, Lozovoy MAB, Dichi I. Effect of soy product kinako and fish oil on serum lipids and glucose metabolism in women with metabolic syndrome. Nutrition. 2014;30(1):112-115. doi:10.1016/j.nut.2013.05.024.
8. Albert BB, Derraik JG, Brennan CM, et al. Supplementation with a blend of krill and salmon oil is associated with increased metabolic risk in overweight men. Am J Clin Nutr. 2015;102(1):49-57. doi:10.3945/ajcn.114.103028.
9. ORIGIN Trial Investigators, Bosch J, Gerstein HC, et al. n–3 Fatty Acids and Cardiovascular Outcomes in Patients with Dysglycemia. N Engl J Med. 2012;367(4):309-318. doi:10.1056/NEJMoa1203859.
10. Ismail A, Bannenberg G, Rice HB, Schutt E, MacKay D. Oxidation in EPA- and DHA-rich oils: an overview. Lipid Technol. 2016;28(3-4):55-59. doi:10.1002/lite.201600013.
11. Gerster H. Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3)? Int J Vitam Nutr Res. 1998;68(3):159-173. http://www.ncbi.nlm.nih.gov/pubmed/9637947. Accessed August 4, 2018.
12. Burdge GC, Calder PC. Conversion of α -linolenic acid to longer-chain polyunsaturated fatty acids in human adults. Reprod Nutr Dev. 2005;45(5):581-597. doi:10.1051/rnd:2005047.

Written by Dr. Guillermo Ruiz of Integrative Health. Dr. Ruiz is an Associate Physician with Integrative Health, interested in the treatment of endocrine disease with a focus on thyroid health. Under the mentorship of Dr. Alan Christianson, Dr. Ruiz expanded his knowledge on the treatment of Hashimoto’s and Grave’s disease and has completed advanced endocrinology training in order to better address and resolve endocrine disease.

Learn more about Dr. Ruiz here

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