Thursday, March 18, 2010

Fish Oil to Reduce Inflammation

Almost everybody is already taking fish oil, right? Unfortunately, a couple of regular fish oil capsules a day does not do much. I recommend supplementing with at least four grams a day of EPA & DHA omega-3 to reduce inflammation. This therapeutic dose is consistent with American Heart Association recommendations for reducing high triglycerides. Please note that this is not four grams a day of fish oil, but 4000 mg a day (4g) of the EPA and DHA omega-3 fatty acids contained in the fish oil. These mega doses of omega-3 can dramatically lower CRP. In one six month study, subjects receiving just 1.5 gram a day of EPA & DHA omega-3 lowered their CRP by almost 40%.
Can you get enough omega-3 from eating fish? It is possible, but very difficult. You would need to eat about 11 oz. a day of salmon (more than $180/month) or eight cans of tuna a day (over $300/month). Regrettably, most fish has traces of mercury, PCB's and other contaminants and may not be a healthy source of omega-3 if over consumed.
Normal fish oil softgels contain just 180mg of EPA and 120mg of DHA per softgel. At this low dosage, you would to take 14 softgels a day for a therapeutic dose!!! An inexpensive bottle of 100 softgels might be as cheap as $3.50 which works out to a cost of about $15.00/month for a therapeutic dose. 420 softgels a month is a whole lot of pill popping!
Higher dose fish oil might contain 300mg of EPA and 200mg of DHA. At this dosage, you would need to take eight softgels per day. A bottle of Swanson Super EPA Fish Oil with 100 softgels costs $6.39 purchased online which works out to just $15.34/month. A little less pill popping, but 240 softgels a month is still formidable.
Now, if you can convince your doctor that omega-3 is a good thing, he/she will probably prescribe the patented prescription omega-3 from fish oil called Lovaza. It only requires four softgels per day, but is very expensive! Doctors generally prescribe it to treat high triglycerides which usually are associated with high CRP. A bottle of 100 softgels is $167.69 at Walgreens which is a cost of $201.23/month!!! Don’t be fooled. This is nothing more than concentrated, very expensive fish oil.
I prefer to take fish oil as a pleasant tasting lemon flavored liquid oil. The champagne of fish oil is Carlson Lemon-Flavored Liquid Fish Oil. You need to take just one tablespoon per day (3 tsp). Remembering how disgusting the cod liver oil of my youth tasted, I was initially hesitant, but, honestly, it really tastes good. A 500 ml (16.9 fl oz) bottle costs $22.19 purchased online from Swanson which works out to $19.97/month.
Taking a therapeutic daily dose, omega-3 has also been shown in studies to lower triglycerides 20-30% and raise healthy HDL cholesterol by about 5% on average. Many diabetics report more dramatic results.
Bibliography of Research on Omega-3 and Inflammation:


  1. Quote:
    Originally Posted by scottietwenty3
    Hi Denny

    I know you recommend carlsons liquid fish oil (lemon flavoured) but its not very easy to get over here and im not a big fan of online shopping. I more do they old fashioned way go to the shop(s) and do my shopping. I know another liquid fish oil its got two words and it starts with N I think but its name escapes me atm. I have found a liquid fish poil that is from an aussie company its available at any of our good pharmacys etc. Can you please give me your thoughts/opinions




    Ethical nutients is the brand

    Hi-Strength Liquid Fish Oil - 170 mL oral Liquid

    Hi-Strength Deodorised Fruit Punch Flavoured Fish Oil (Gelatin Free).

    Each 5 mL (by measuring cap) contains:
    Concentrated Omega-3 triglycerides - fish
    4.6 g
    Equiv. Eicosapentaenoic acid (EPA)

    1.9 g
    Equiv. Docosahexaenoic acid (DHA)

    927 mg

  2. Scottie,

    Good questions (which you posted on Diabetes Daily) that I prefer to answer here to share with others.

    I regard fish oil as a commodity. It all works. If it is not properly processed and fresh, however, it may be oxidized (rancid) and have an unpleasant fishy taste. If the fish oil is made from large fish like tuna and is not molecularly distilled, it could have heavy metals, PCBs and other toxic pollutants. Good fish oils are made from small fish at the bottom of the food chain and the oil is molecularly distilled. Carlson has consistently good quality. Another good brand is Nordic Naturals. There are other good brands that I am not familiar with.

    Typical fish oil has an EPA to DHA ratio of 3:2. EPA seems to be most important for heart health and macrovascular issues. DHA is more important for the development of cognitive, neurological and visual functions (especially in kids) and preserving good cognitive function, neurology and vision as we age. The Aussie product you reference has a larger amount of EPA than usual. This is a product that might be best for heart health.

    As for the quality, if it does not have any strong fishy tastes, it is probably fine.

  3. Denny

    I got some of the Ethical Nutrients fish oil the other day as discussed above. To now answer your question it has not fishey after taste what so ever.

    This is my first ever venture into fish oil "so im must have been one of the very few fish oil virgins left until a couple of days ago lol.

    It says on the bottle it undergoes molecular distilation which I trust is a good thing? I assume that means it mercury free? It also says its caught from the wild open oceas. The best thing is its readily available over here along Carlsons. It will be interesting to see if overtime fish oil supplementation improves any of my labs.

  4. If you take enough fish oil, it should reduce your C-reactive protein and lower triglycerides very significantly. 4 grams a day of EPA and DHA is a therapeutic dose.

    Do you know your CRP and triglycerides before you start taking fish oil? Let us know the effect in about six months.

    Almost all fish oil is molecularly distilled. Yes, it should remove the heavy metals and PCB residues that might be present. Most fish oil is made from less commercially valuable small fish which are lower on the food chain and have less pollutants.

  5. Denny

    Last time I had my triglycerides run late Feb 2010 they where 0.8 mmol/L I think that converts to about 71 mg/dl I was dx with T2 diabetes early Feb this year. My triglycerides in early Jan this year where 1.1 mmol/L (98mg/dl) so I have really got stock into the weight loss excercise and diet since my dx. I dont low carb id more say im a moderatate carber. What ever im doing seems to be working as all my labs have improved (not that the where bad pre dx) im hoping that the fish oil my bump up my HDL that is a little on the low side 1.1 mmol/L (about 42.5 non metric I think). Yes I just got my CRP done in June (for the first time ever and it was 9) so im not ultra happy with that number but atleast that gives me a baseline. My GP said its nothing to really worry about, I just want to improve on it eg it would nice to get it into a normal range which I thinks is sub 3. I have many of your posts on DD I remeber you saying on more than one occasion that is quite common for T2's ro have elevated CRP. Time will tell if this fish oil will improve anything I personally can only see only positive things coming from it. What was you last CRP and trigs?

  6. Forgot to add im only taking 3 grams a day of EPA and DHA from fish oil although I have a fair amount of flaxseed meal on my youghurt although I know we convert only a very small amount from plant sterols. The way I look at though is its 3 grams more a day of EPA and DHA from fish I was getting up until a few days ago.

  7. Scottie, That's a great triglycerides number, but your CRP is definitely too high. In most T2s, both numbers would be high. Both come down with weight loss and low carbing. Fish oil can bring them down even more.

    My triglycerides were last measured at 86 mg/dl (0.97 mmol/L). CRP was 2. I think Tg should be <100 and CRP < 1.0. Still working on it.

  8. Denny

    Is that fasting of yours of CRP of 2 is after you did that extended fasting last year? or after intementant fasting which also lowers your CRP. As I cant rember if I read it her or on DD that you mentioned your reduced your CRP from 8 to 2 by intermitent fasting is that correct?

  9. Oops forgot to add again does it often take a little time for your CRP to come down with fish oil supplematation or does it drop very quickly? Like ive read intermittent fasting can drop it like a stone.

  10. In A 12 week study of 27 participants, those consuming 1.3 grams of EAP + DHA per day lowered their CRP by 24% during the study period.

    I advocate using 4 times as much fish oil and doing it for the rest of your life. Not sure how fast it will work for you and how much it will reduce your CRP. I would guess it varies with individuals and is greatly affected by the rest of your diet. Specifically, consuming polyunsaturated oils which are high in omega-6 and eating simple carbohydrates high in fructose may undo the positive effects of supplementing with omega-3.

    I was surprised my CRP was 2 at the end of a period of fasting because I felt achy all over and terribly fatigued. These are usually symptoms of chronic inflammation. I honestly am not sure what long-term effect, if any, fasting has on CRP. I have not seen any good studies.

    If you can afford to do regular CRP testing while experimenting with fish oil, fasting, low carbing and other interventions, be sure to publish your numbers. We can learn from your experiences.

  11. I will get my CRP taken again in November so it will be interesting to see then im not low carbing as I have mentioned before im moderate carbing but I dont have to many simple carbohydrates I go more go for the complex ones (low GI). AS for experimenting with fasting I cant see that is for me.

  12. Denny

    On this point you make

    Specifically, consuming polyunsaturated oils which are high in omega-6 and eating simple carbohydrates high in fructose may undo the positive effects of supplementing with omega-3.

    Is regular store bought margarine considere a polyunsatured oil? As I always thought it was monounsaturated? I do get confused some what on this one. I know the oneI have in the fridge atm is made from sunflower seed oil. I use very small amounts daily. Along with lots of flaxseed meal and a little olive oil.

  13. Scottie,

    Check out my chart on common oils and fats.

    Sunflower seed oil in loaded with unhealthy omega-6. Olive oil is more benign with mostly monounsaturated fat and some interesting phytonutrients, but it still has some omega-6. Flaxseed has a good omega-3 to omega-6 ratio, but it is the plant based ALA omega-3, not the more active EPA and DHA found mainly in marine sources.