Omega-3 Fatty Acids and Heart Health: Algal, Krill or Fish Oil Supplements
Most people do not consume enough fatty fish containing long chain omega-3 polyunsaturated fatty acids (ω-3 LCPUFAs). Consequently, our intake of the ω-3 LCPUFAs - eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – is low. ω-3 LCPUFAs help reduce production of triglycerides by the liver and increase triglyceride clearance. Increasing ω-3 LCPUFA intake can also increase HDL-cholesterol concentrations. Based on this evidence, the FDA approved the use of omega-3 LCPUFAs in the treatment of hypertriglyceridemia.
Outside of eating more fish, the most common sources of EPA and DHA are fish oil, algal oil or krill oil supplements. In a comparison of krill oil versus fish oil products, Nash and colleagues report that krill oil products are the most expensive oil per milligram of DHA + EPA. The krill oil products also had higher levels of persistent organic pollutants (POP) thank fish oils. Red blood cell concentrations of DHA, EPA and the ω-3 index are increased when people supplement diets low in ω-3 LCPUFAs. Red blood cell ω-3LCUPFA concentrations increase when people consume more EPA and DHA.
Bioavailability claims regarding krill vs fish oil ω-3 LCPUFAs predominantly reflect differences in DHA+EPA content rather than form (phospholipid-bound vs ester-bound vs unbound). In fact, pharmaceutical products are sold in ethyl–ester and free fatty acid forms because they are efficacious.
According to an economic report by Frost & Sullivan, $16.5 billion in expenditures could be saved between 2013 – 2020 if US adults 55 years and older with coronary heart disease used ω-3 LCPUFA supplements. Estimates are that health care savings would amount to $4 billion. That is a lot of money.
A preventive intake is 1,000 mg DHA+EPA with a median daily cost per consumer of ~$0.25.
For more detail on coronary heart disease and the cost effectiveness of ω-3 LCPUFAs, see the full chapter.
The Medical Letter on Drugs and Therapeutics. Fish oil supplements. 2014 JAMA doi: 10.1001/jama.2014.9758
Nash SMB, Schlabach M, Nichols PD. A nutritional-toxicological assessment of Antartic krill oil vs fish oil dietary supplements. 2014 Nutrients doi: 10.3390/nu6093382
Stonehouse W, Conlon CA, Podd J, Hill SR, Minihane AM, Haskell C, Kennedy D. DHA supplementation: improved both memory and reaction time in young adults: a randomized controlled trial. 2013 Am J Clin Nutr doi: 10.3945/ajcn.112.053371
Salem N, Kuratko CN. A reexamination of krill oil bioavailability studies. Lipids Health Dis 2014 (epub ahead of print).
Smart Prevention – Health Care Cost Savings Resulting from the Targeted Use of Dietary Supplements. An Economic Case for Promoting Increased Intake of Key Dietary Supplements as a Means to Combat Unsustainable Health Care Cost Growth in the United States. Frost & Sullivan, 2014