The guys at Examine.com are awesome when it comes to sifting through nutritional research and finding the most direct answers possible to the most common questions about supplements, their effectiveness, and how to use them properly to get specific results. They’ve previously been gracious enough to write guest posts on whey protein, vitamin D, and creatine, and are back again today to continue their series on fish oils. They always knock these out of the park and today is no exception.

To say fish oil is popular would be understating it. When it comes to the athletic population, many take it, expect it to reduce post-workout soreness and to improve cognition, and even improve cholesterol. Does it hold up?

Three things you probably already knew

1. One of the most important things to worry about when supplementing fish oil is the ratio of omega-3 to omega-6.

One of the most important things to keep in mind when supplementing fish oil is the ratio your body maintains of omega-3 fatty acids to omega-6 fatty acids. Fish oil is ‘stored’ in the body, in the cellular membrane (the barrier that protects each cell). This membrane is made up of fatty acids. The body can use the fish oil stored around each cell to make signaling molecules called eicosanoids.

The mechanism your body employs to to create eicosanoids doesn’t care if the fatty acids it calls upon are omega-3 or omega-6. If your cellular membranes are packed full of omega-3 fatty acids, then the body will release primarily omega-3. Similarly, if you have an overabundance of omega-6, the body will choose to release omega-6 instead.

The body functions best when there is a balance of omega-3 and omega-6 fatty acids. There is no consensus on whether a 2:1, 1:2 or 1:1 ratio is ideal, but either of the three is far more beneficial than a ratio of 10:1 or 1:10. Our typical western diet tends to be heavy on omega-6 fatty acids and light on omega-3s.

2. Fish oil is a very potent triglyceride reducing agent, but it is only moderately beneficial in reducing cholesterol

Have you heard of the pharmaceutical Lovaza? It’s a patented blend of eicosapentaenoic acid ethyl ester and docosahexaenoic acid ethyl ether, made for the treatment of hyperlipidemia. In other words, EPA and DHA in ethyl ester combine to reduce triglycerides. It’s one of the best supplemental options to reduce triglycerides available today, potentially cutting triglyceride levels 20 to 40 percent, depending on how high triglyceride levels originally were.

Fish oil, on the other hand, is comparatively lackluster. In otherwise healthy people with elevated cholesterol, fish oil supplementation will decrease the LDL cholesterol while increasing HDL. However, people with poor cholesterol will experience a mild elevation of LDL. This increase is too small to be of concern to most people, but the only people to actually experience this increase already have poor cholesterol and thus should be wary.

For this reason, Lovaza should be considered alongside statin use. For supplement users, fish oil should be considered alongside garlic or berberine (other supplemental options for reducing cholesterol).

3. Fish oil augments muscle protein synthesis and muscle cell metabolism

There are two main mechanisms by which fish oil benefits muscular health (beyond joint benefits and inflammation) which can result in increased physical performance and muscle growth.

The first is known as metabolic flexibility, or how fast and easily a cell can switch from using glucose as its primary fuel source to using fatty acids. Metabolically flexible cells are correlated with better physical performance in tasks that benefit from switching energy sources. Activities like football, martial arts, or intermittent exercise are great examples of these tasks. They are characterized by alternating from a relatively low intensity waiting period to a high intensity activity.

When a cell receives omega-3 fatty acids, it tends to become much more metabolically flexible.

Fish oil can also aid in protein synthesis and muscle growth. Cells contain a protein called mTOR, which mediates muscle protein synthesis. Activating the mTOR protein can promote muscle growth. While fish oil does not directly activate mTOR, it enhances the activation of mTOR from other stimuli, like leucine or insulin.

Three things you may not have known

1. Not all effects of fish oil supplementation are due to the ratio of omega-3 and omega-6

Many fatty acids work by being stored in the cell membrane, waiting to be called upon by the body in times of need.  The PUFAs (omega-3 and omega-6 fatty acids) are by far the most important fatty acids to be stored in your cells, since they form potent eicosanoids.

A cell can be in one of three stages:

1. The ratio of omega-6 to omega-3 is 10:1, with total PUFAs making up 5% of the cell membrane. This suggests an inflammatory state.

2. The ratio of omega-6 to omega-3 is 1:1, with a total PUFA content of 15%. This might happen if you overload your diet with fish oil in an attempt to normalize the ratio. This cell is balanced in omega fatty acids, but due to the high PUFA content, the cell membrane is more easily oxidized (not a good thing), but it is more flexible.

3. The ratio of omega-6 to omega-3 is 1:1, with a total PUFA content of 5%. This leads to a similar inflammatory state as stage 2, but with less vulnerability to oxidation and less flexibility.

 There will always be debate on whether a higher or lower total PUFA content is good or bad, since the increased susceptibility to oxidation is usually considered to be a bad thing, but greater cell flexibility is not.

People that warn against fish oil consumption tend to be referencing the cellular vulnerability to oxidation, which occurs due the general effect of PUFAs, but does not depend on omega ratios. These concerns are warranted, but fearmongering is not, since this issue should not deter anyone from fish oil consumption. A daily dose of anthocyanin rich foods, with some vitamin E, will more than negate the increased susceptibility to oxidation.

2. The benefits of fish oil on cognition are not as consistent as you think

When it comes to determining the effects of supplements on cognition, there are three distinct demographics of people that need to be considered:

1. Older individuals beginning the process of cognitive decline, or those who are already in a state of cognitive decline.

2. Young people with a cognitive incapacity or condition (i.e, a brain injury or chronic depression).

3. Young people with no known cognitive incapacity or condition.

Fish oil is beneficial for people with severe depression and for people that have suffered from brain damage (assuming that antioxidants are also being supplemented in the latter case). Fish oil is also generally reliable for older people, though not 100 percent of the time.

Young people that want to increase cognition may want to look elsewhere. Fish oil is incredibly unreliable at increasing memory and cognitive processing. Though individual studies will show the benefits of fish oil on these processes, the collective body of study will show an inconsistency in results, suggesting a missing factor that still remains to be isolated. For this reason, fish oil cannot be relied upon to increase cognitive capacity in young people.

3. The differences between forms of fish oil are really overrated

Fish oil comes in a variety of packages. You could purchase the triglyceride form (the most common), the ethyl ester form (Lovaza), a phospholid form (krill oil), and oils from specific species, including cod, salmon, and shark. Due to the popularity of fish oil, there is a lot of debate on the best kind of fish oil.

Phospholipid forms are better than the triglyceride, which in turn is better than ethyl ester, strictly based on absorption rates. If, for example, triglycerides are absorbed at a value of 100% (this figure used for example only), then ethyl ester checks in at 66%, while phospholipids hits the high mark at 150%.

However, the rates of absorption and overall bioavailability only matter if the compound needs to hit its peak efficiency in the blood at a specific time. Fish oil is not time dependent and only needs to be present in the diet. For this reason, absorption rates should be used as a guideline when taking multiple forms of fish oil. For example, if a subject supplements with 1g of fish oil, they may only need 700mg of krill oil to achieve the same effect.

Krill oil appears to be the most useful on paper, due the lower required dosage, but its prohibitive price does not validate its usage. Salmon and cod liver oil should be used if a dose of astaxanthin or Vitamin A and D is desired, while shark oil should be avoided due to mercury concerns.

Since the benefits of fish oil are primarily derived from the fatty acids themselves, the differences between the various forms of fish oil are interesting but not worth micromanaging and worrying about.

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