If you're watching this video, then you for sure heard about omega-3 fatty acids before. Some people say they're the most important thing in the world, other people say they don't matter. What's the real truth? Well, that's what we're gonna talk about in our podcast today. We're gonna dive into what omega-3 fatty acids are, what they're used for, and what their real health benefits are. So let's get started. And welcome back everybody to the Building a Lifelong Outfits podcast. Thanks so much for stopping by, I really appreciate it. We haven't had the chance to meet yet. My name is Jordan Wrennke and I'm a dual board certified physician in family and sports medicine. And the goal of this podcast, keep you active and healthy for life through actionable evidence for education. Today we're diving deep into the world of omega-3 fatty acids, specifically EPA and DHA. These are essential nutrients that is getting a lot of buzz lately. People talk all about them and they are important, but we're gonna cut through all the noise and give you kind of the clear evidence-based breakdown on what they are, how much you really need, where to get them and what food sources, all that stuff. So let's do it and let's get started. So first things first, let's talk about the basics. So let's start with the fundamentals. What exactly are EPA and DHA? That's a good place to start. You hear about fish oil, but does anyone actually talk about it? That's what we're gonna walk through first. So omega-3 fatty acids, they represent a class of polyunsaturated fats. So we talk about saturated fats, things like butter and ghee, and then we have unsaturated fats, things like here in omega-3s, you think more of like olive oil, avocado oil, stuff like that. But they represent a class of that and they're absolutely crucial for human health. Within this group of these fatty acids, we have icosapentanoic acid or EPA and docosahexaenoic acid or DHA. So obviously I'm just gonna say EPA and DHA 'cause that's a mouthful, but those are the really, really big ones, particularly important 'cause they're long chain omega-3s. And yeah, you primarily find them in marine sources like fatty fish and fish oils. And these fatty acids are actually integral components of cell membranes throughout the entire body, especially in the brain and eyes. So they serve lots of different roles as well. So they serve as precursors to signaling molecules involved in lots of bodily processes. And yeah, they work with inflammation, blood clotting, and lots of other vital functions. So they're really, really important 'cause they're used for a lot of different things. And their importance is underscored by links to numerous health benefits as well, including cardiovascular health, brain function, eye health, joint health, maybe proper fetal development as well, lots of things. So there's a lots of stuff going on. And while your body can technically try to make EPA and DHA from shorter omega-3 precursors like alpha-liminalic acid or ALA, which come from predominantly plant sources, the conversion process is pretty inefficient in humans. It's really hard to get this number. So obtaining adequate amounts of these EPA, DHA directly from your diet is probably gonna be more beneficial and actually gonna get you the levels that you actually need. And however, despite widespread public interest in scientific investigation, there's a lot of confusion around omega-3 fatty acids. You'll hear questions constantly about the appropriate dosage and the validity of various health claims out there. What are the best sources? What are the risks? There's lots of things to talk about and that's why we're doing this here. And at the end of the day, let's be honest, marketing messages out there can sometimes be directly, they can directly conflict with what the science says or what other people are telling us, right? So it's just adding to uncertainty. If I had a dollar for every time someone says, I can't eat anything anymore because this person over here says I should do this and this person says I can't, that's never my goal. My goal is to kind of clear things up. I will tell you at the get go right now, whether you take DHA, EPA, or you take omega-3s, you can live a long healthy life and never supplement. I guarantee that. Now you may have to eat some food like fish that will get you there, but it's one of those things where this is not a prerequisite to supplement, but it is a crucial molecule to have, so we wanna make sure we're getting enough. But that's just what I wanted to say. So that's the intro to that, what the basics are. Hopefully you have a little bit understanding of what's going on. Next, let's talk a little bit more though, going into the ALA versus EPA and DHA. And this is a super important distinction and a fundamental source of a lot of confusion when people hear about the general term omega-3s. It's really critical to understand and distinguish between plant-derived ALA and the marine-derived EPA and DHA. So ALA is an essential fatty acid, meaning your body can't make it, and therefore we must obtain it from our diet, right? So essential means we gotta have it, but we don't make it, so we gotta get it. However, it's conversion to the larger change, like we talked about the EPA and particularly DHA, it's really limited in humans, hard to do. Studies consistently highlight there's a low conversion of this, it's very hard. So as a result, relying solely on ALA-rich foods, like flax or chia seeds, it's unlikely to significantly raise your EPA and DHA, to the levels that we want them for healthy living. So eating just these foods, a lot of times people say chia seeds are great in omega-3s. They are great in omega-3s, they're great in ALA, and so it's a little different though. So yeah, that's what we have to think. It's hard to get the ALA to convert to these EPA and DHA, and that's what we really care about. So most of the well-studied benefits of the omega-3s are particularly coming from EPA and DHA, and those are the ones, once again, we get from fish, krill, or algae sources, and understanding this difference is really, really important 'cause as you'll see, people will say, "Hey, I get plenty of omega-3s. "I eat chia seeds like they're going out of style. "I eat flax seeds like they're going out of style. "Okay, that's great, we're getting ALA." But once again, the conversion from ALA to over those, I'm sorry, to the EPA and DHA, that's not very good. And so we have to get other sources in our diet to get kind of the full profile. That's kind of what I think about. We're gonna make all the rounds here to make sure we get enough of each and every one. So that's the key distinction there. And then moving on from that, let's talk about general recommendations. So there's lots of general recommendations on omega-3s from all over the place. We'll kind of talk about them here. But determining the optimal intake of EPA and DHA can feel really complex at times, right? You're trying to navigate this complex landscape of recommendations that vary depending on your health goals and just really the population groups they're talking about. That's the thing. A lot of times you'll see a number, right? And spoiler alert, if you see a number, odds are it's probably not gonna work for every single person. And that's everywhere in medicine. You know, there's usually a range of things, and I think we'll show that here. There's a range of things and that's reasonable. But if someone says, "This is the dose you need to be on," I'd be wary of that just because we don't know if that's gonna work for you, if it's gonna be too much, too little, who knows? But yeah, we're gonna look at a big range here. But when we look at general health recommendations, it's a bit of a patchwork picture here. There's currently no official dietary reference intakes or DRIs specifically for EPA and DHA in the United States. However, several authoritative bodies have definitely issued recommendations primarily based on cardiovascular health studies and considerations. So for example, that the AHA, the American Heart Association, they recommend consuming two servings of oily fish per week with some sources citing that, you know, we should have specific recommendations of 400 to 500 milligrams per day of combined EPA and DHA. So stepping back though, AHA essentially says two servings of oily fish would be great and maybe 400 to 500 milligrams a day of these combined. The 2015 to 2020 dietary guidelines of Americans advise consuming about eight ounces of seafood per week, providing approximate 250 milligrams of EPA and DHA for general adults. So we're seeing anywhere from 250 to 500 per day, general recommendations, but, you know, four ounces of seafood per week. That seems like two four ounce servings. So that's pretty consistent there as well. For pregnant and lactating women, the recommendations increases to eight to 12 ounces per week to support infant health, particularly DHA intake. The European Food and Safety Authority recommends 250 to 500 milligrams a day of combined EPA and DHA for adults in general, just to reduce cardiovascular disease is what they said. And so synthesizing all this, a general consensus range for maintaining overall health in otherwise healthy individuals appears to be 250 to 500 milligrams per day of combined EPA and DHA. And making that more practical, when I see that, you know, we'll talk more about labels and what you're reading on. When I see that, you can also extrapolate that and say, hey, about two servings per week of fatty fish is what kind of what it comes down to. So 250 to 500 or two servings a week of fatty fish seems to be a general sweet spot for general health. Moving on next here, talking about specific conditions now. So this is super important. When we talk about therapeutic dosing, we're talking about substantially higher amounts for specific medical conditions, right? You will see online, lots of people will say, take this dose because this is a quote optimal dose. And you know, this is something you see all the time in the functional medicine world. They say, this is the optimal dose. And they're saying it just because, and I don't know why, but this, what we're talking about here is specifically for specific medical conditions. So at these higher levels, Omega-3 function more like pharmacologic agents targeting specific physiologic pathways involved in disease processes. So that's the idea of why we're doing so high here. For hypertriglyceridemia, meaning you have high triglycerides, for individuals with elevated levels, a therapeutic dose is about two to four grams or 2000 to 4,000 milligrams per day of combined EPA and DHA, and that's recommended. The dosage, the range effectively reduces triglycerides levels anywhere from 20 to 50%. So if you have hypertriglyceridemia, I was just talking yesterday with one of my learners saying, hey, if you have up there and someone's already on a cholesterol-lung medication, it's not working, you can absolutely add on fish oil at a higher level to help decrease triglycerides. That's a well-known and established reason for why we use them, but yeah, hypertriglyceridemia, definitely a reason. For secondary cardiovascular disease prevention, so secondary means you've already had an instance. So you've had a stroke or a heart attack, so for secondary prevention here, this is kind of the general recommendations. The role of Omega-3 is a little complex. It's not as clear cut. And so there are several RCTs that like to combine EPA and DHA that showed, that did not show a significant reduction in major adverse cardiovascular events or MACE, and they looked at high dose ones as well. And on the other end, high dose EPA only. So before EPA, DHA didn't see a big change. In the high dose EPA only, they did see some positive results. For example, there was a reduce it trial, which demonstrated a substantial 25% relative risk reduction in major adverse cardiovascular events with four grams per day of EPA in patients at high risk. So that's the big thing. And they've already were taking statins. So mixed kind of there. So it's not as clear for secondary prevention, can be helpful. For a mood support or depression, anxiety, nothing's like, first and foremost, this is never gonna be like a formal form recommendation. There's not as much research there, but some people talk about using it for that. There is some research on this though, and research has produced inconsistent results. But there was a meta-analysis I looked at that suggests potential benefits, especially from EPA enriched formulations with doses up to 2000 milligrams a day. So that's one thing they mentioned there. For rheumatoid arthritis, omega-3 fatty acids, they help with anti-inflammatory pathways into what is, and the doses here they looked at were higher about three grams per day with combined EPA, DHA. And there's not a whole lot of data on that in terms of not huge robust RCTs or meta-analyses, but there were some studies that showed that could be helpful so that's about three grams per day. And then regarding the safe upper limit, while specific tolerable upper limit intakes haven't been formally established by any authorities, they kind of say that overall they say five grams per day or 5,000 milligrams is probably the upper limit. Where we, hey, we can safely say that we go up to there and we don't have a significant increase in our risks or lots of safety concerns. And so we'll talk about side effects later. That's a lot, five grams a day is a lot. So we should compare, you know, these are anywhere from 2,000 to 4,000 for these therapeutic level compared to our previous ones where we're talking like 250 to 500. So a very, very big difference, you know, we're talking four, six fold what it would be. So you'll see online a lot of people say you should be taking, you know, how many of these grams per day. And unless you have a specific condition that may not be the case. So just something to think about, look at, well, I'm just presenting out there, you do what you want, but that's just what I saw. And another big thing I wanna mention is reading the labels, right? So this is a big one, reading supplement labels can be a common point of confusion for consumers or anybody, right? So the total amount of fish oil listed per capsule or serving is not the same amount of the active ingredients, EPA and DHA. So a lot of times you'll see quote unquote fish oil, and they'll say, you know, two grams of fish oil. Well, that is very different from the active ingredient EPA and DHA. So you have to look at the actual supplement facts and then kind of look at specific quantities of EPA and DHA per individual thing. So you have to look at per capsule or two capsules or whatever the serving is, you have to look at that. And achieving a therapeutic doses may therefore require consuming a significantly larger quantities than you think, right? You look and you see the serving size, it's like, oh, like this is two pills as a serving size. And that gives you 500. And you're trying to get four grams, you're gonna be just taking a bunch of pills. And so there's something to consider there. There's definitely gonna be there. Some supplements are more concentrated. So you have to once again, look at it. Some contain up to 90% EPA and DHA, which does reduce pill burden, but you really have to look at. The FDA does prohibit certain nutrients contents, claims like high in EPA and DHA though, because no official daily value has been established. So if someone's saying it's high in this, what's high, who knows, we're kind of making out. And I think once again, this really reinforces the importance of focusing solely on the specific milligram amounts of EPA and DHA on the supplement facts panel. So you're looking at that, that's the most important thing. And it's also worth mentioning that nearly 60% of tested supplements contained less EPA and DHA than stated. And the majority required more than one capsule to provide 80% of the daily requirement, underscoring the need for your due diligence. And that's a common theme we see over and over and over again is that supplements can pretty much do whatever they want. They can go out there and there's no real testing for purity, for concentration. And that's like the biggest thing with supplements. That's why when you do get a pharmaceutical grade, you know exactly what you're getting, which is helpful. And I know everyone's like, oh, pharma. One thing is like we have at least standards there that like we know what we're getting where supplements, you know, and I'm not saying that's no supplements. There's definitely reputable supplement brands out there, but the biggest thing you have to ensure that you're getting a reliable and safe supplement and working through a supplement company. So there's other resources, things like LabDoor, you can look at and kind of find ones that actually match 'cause they've actually, some supplement companies will do this on their own. They'll pay for it to get tested to say, hey, look at, we actually do this in a right way. And that's the kind of company you wanna look for. And however, though, to make things a little bit easier, here's a quick summary of the EPA DH intake recommendations we've discussed previously. So general health, 250 to 500 milligrams per day of combined EPA and DHA. Pregnancy, the normal dose are 250 to 500 plus an additional one to 200. So anywhere from looking at 350 up to 700. Hypertriglyceridemia, two to four grams or 2000 to 4,000 milligrams per day of combined EPA, DHA or EPA only. Secondary prevention, questionable if it does work, but 1800 to 4,000 milligrams. So 1.8 grams to four grams. Mood support abrasion about up to 2000 milligrams or two grams per day. Rheumatoid arthritis about 3000 milligrams per day. And then the upper limit, I would say it was kind of safe, was around 5,000. So as you see, wide ranging ones there. That's what we wanna look at. Next, let's evaluate the evidence of the actual health benefits. So we do wanna talk about this. I just mentioned the dosing of there 'cause that's what it is. Now we kinda go into this a little bit further. So I wanna get kind of into the nitty gritty, the actual health benefits of this 'cause there's claims that they can do everything, right? From improving your cognition to reducing your risk for a heart attack, all those things. So the supporting evidence though really varies quite a bit across these different health outcomes. So I wanna talk about that. When it comes to cardiovascular health, triglyceride lowering, it's pretty good here. The evidence is pretty strong. As I mentioned before, therapeutic dosing of around two to four grams, it consistently reduces triglycerides by about 20 to 50%, which can be helpful. What about decreasing heart attacks or strokes or MACE, major adverse cardiovascular events? The evidence is mixed and inconsistent. While some trials showed combined EPA and DHA didn't really reduce MACE, high dose EPA seemed to show positive results in specific populations. As I mentioned before, like that reduce it trial did seem to be helpful. That was just high EPA. So something to think about. From a blood pressure perspective, there did seem to be a modest reduction. They've seen a couple studies with higher doses around three grams per day, but certainly not a first line agent for antihypertension. For cognitive function, dementia, DHA is structurally important for the brain, right? So the idea is that, hey, if it's all up in the brain, maybe this helps support it. But the evidence isn't really fantastic. It's kind of mixed, right? And a clear causal link between EPA and DHA supplementation and the prevention of cognitive decline or dementia is not really established. The strength of evidence is considered pretty limited based on insufficient number of sources, but it's one of those things where maybe it's helpful. We don't know. And that's gonna be pretty much every supplement research ever is gonna be like, I don't know, maybe, I don't know, maybe. And so all I'm trying to do here is just inform you of the things that may be helpful, the doses we wanna think about, the side effects which we'll talk about in a little bit, and then you can make the decision for yourself. But I'm not gonna tell you what's right or wrong. I'm just gonna present the information. Like my old pastor used to say, "I'm just one beggar to another beggar telling you where to find food." That's essentially my whole role here. And for mood disorders that we talked about before, like anxiety, depression, research has produced, once again, inconsistent results, but there was a meta-analysis that showed potential benefits, specifically from EPA ones above 2000 milligrams a day. We mentioned for rheumatoid arthritis before, mixed studies. And that's kind of there. For ADHD, there's one that I looked at specifically ADHD, there's not a whole lot of studies on that. Some people say it's beneficial anecdotally, but there doesn't seem to be a strong consensus in data saying that's what's gonna help. And then eye health is another one people talk about. So we do know that omega-3s are found in the eye. And while DHA is a major structural component of the retina, the evidence, once again, for general eye health or specific conditions is limited or insufficient. And then finally, for pregnancy and infant development, the importance of DHA for fetal infant brain and eye development is well-recognized with strong evidence that maternal intake influence their consumption patterns. And so overall, if I had to sum this up saying, what is it really, really good for? It's really good for low-integral seroids at a really high level. Like that seems to be pretty strong. It seems to be very beneficial for pregnancy, helping infants grow. That seems to be helpful from a mood perspective, I don't know, from an arthritis perspective, possibly may be helpful. From other reducing your cardiovascular risk for heart attack, maybe, maybe helpful. And so this is where we're like, we really make our money, right? In terms of how do we decide what's worth it for you? Is the risk versus the benefits, we have to kind of consider those. So just something to think about. Hopefully you're not more confused. And so moving on here, you're probably asking though, where do I actually get DPA and DHA omega-3s? Where do I get it from? And so I wanna talk more about the sources along with their characteristics and help make you make the best choice. So let's first start with the primary dietary and supplement sources. So first is fatty fish. The most common dietary sources are cold water fatty fish, things like salmon, mackerel, herring, sardines, and tuna. So this is why you see that influencer online that's just cracking open sardines and eating them. It's 'cause of omega-3 and we're getting it there. Absolutely. You also have these fish oil supplements. So derived from oily fish tissues, these are widely available in liquid or capsule form. These are the ones that give you the fish burps when you take the medications. So that is very prevalent there, but this is one we probably see the most common, right? Is fish oil supplements. We also can have krill oil supplements. So these are extracted from small shrimp-like crustaceans. They provide EPA and DHA primarily in phospholipid form and naturally contain the antioxidant and saxon as well. So as the saxon is a fun word to say. It can have this little antioxidant. Usually it's a little bit more expensive, but this is another source if you can't tolerate the fishy burps or whatnot, that's there. We also have algae oil supplements. So cultivated from marine algae, this offers a vegetarian or vegan-friendly alternative to fish or krill oil. And yeah, those are the big main ones there, but fish oil supplements also come in several chemical forms, which can affect their absorption and concentration as well. So we have the natural triglyceride form or TGs. This is the form naturally found in fish. Then we have the ethyl ester, and this is a process form to concentrate and purify the oil common in many affordable supplements. Absorption, however, may be less efficient. And then we have the reformed or re-esterified triglycerides which is concentrated essentially of the ethyl ester. It's a concentrated ethyl ester oil converted back into a triglyceride structure. So we mentioned natural triglycerides. That's kind of the main natural form, probably best absorption. Then we have the ethyl esters, which are kind of a process formula. And then these re-esterified ones, we take that ethyl ester and convert it back into a triglyceride structure, aiming for hopefully better absorption. That's kind of what we think about. And then there's also free fatty acids. These are also suggested to have good absorption, but that's kind of what we look at. And when we compare bioavailability, which bioavailability means how much of this is actually able to be absorbed in the body. That's what we're looking at. That's honestly the most important thing 'cause if you have this insane concentration, but it's not bioavailable, then you're not gonna absorb it and it's not gonna do anything. So when we do compare and look at these though, evidence suggests that EPA and DHA in natural triglyceride form or the re-esterified or free fatty acids are probably the best absorbed. So potentially more efficient than that ethyl ester kind of form. That's generally what we're looking at there. However, the most critical factor remains achieving the target absolute intake of EPA and DHA. And so we're kind of getting semantics here. So if we are looking at these free fatty acids, these natural triglycerides, these re-esterified triglycerides, they probably have the better absorption. So that's probably true. But overall, it seems that the most important thing is just the amount of DHA and EPA you're getting. So the ethyl ester form is probably gonna be a lot cheaper. And as long as it has enough, that's probably gonna be the most important thing. So that's kind of what we're looking at there. The most important factor is that. And it's really important to reiterate here as well the distinction between a plant-based ALA and versus preform EPA, DHA, ALA, like I said, found in flaxseeds and chia seeds, walnuts, certain vegetable oils. It's a precursor to these EPA and DHA, but it's very bad at converting to that. So relying solely on ALA sources, probably not gonna get you where you need to be specifically. So that's just why we're mentioning. And so if you do eat a vegetarian or vegan dietary pattern, so looking for algae oil or something might be helpful to kind of get that additional EPA and DHA that you're not getting. And then a common question that pops up about wild versus farm fish, so especially salmon, right? We talk about how the salmon is raised. Is it in the ocean or is in the stream or is it in a farming stocking kind of farm? That's what we're looking at. And it may affect their omega-3 content. However, the sources that I've seen, and I didn't do an enormously deep dive on this, I apologize, it is kind of hard to pick out, right? So it didn't contain specific information or comparative data addressing a lot of these questions. So we do know that wild salmon generally has higher omega-3 levels, while farm salmon typically is a little bit lower, but it really depends on their feed, right? So, but properly fed salmon, even in a farm setting, could potentially still be a good source of omega-3s. So I'm not saying it's not, but yes, you probably will have a better ratio with wild caught than farm. So that's kind of what it is. And I've done a lot here on this slide, I apologize, but let's summarize kind of different omega-3 sources in a quick comparison. So fish oil, there's those three different kinds, right? So we have the pure triclosurides, the ethyl ester, and then the rheasterified version. These provide EPA and DHA kind of both usually, using medium to high concentration. Cost can be low to high depending on what's going on, but that's there. Krill oil, once again, that does provide our EPA and DHA, but they're bound to phospholipids, and usually it's a lower to medium concentration, but a higher cost, but that's kind of what it is. And then algae oil does provide EPA and DHA at the medium to high concentration and medium to high cost, and usually a more sustainable source for someone who's on a vegetarian or vegan diet. And then plant oils and seeds have that ALA, and once again, ALA is cool and great, but not that beneficial for getting EPA and DHA. So that was the general idea of the different sources. So I do wanna talk about safety now. So now it's time to talk about the safety profile of supplements. And yeah, this is really important 'cause people will tout on the internet that you should just take however much fish oil, don't worry about it, there's no side effects at all. That is not true. Anything you take will have side effects. I say this all the time. If someone tells you that, hey, you can take this and there's absolutely no side effects, I'd be worried about taking that because we want to have the, at least the mechanism of why it could cause side effects. What I mean by that is, if something won't cause any side effects, if they say, hey, you will not have side effects with this medication, then I'd be worried that the medication's not gonna be strong enough to actually do anything, right? We need to exert a physiologic effect on the body. And so if someone says no side effects, then you're probably having actually nothing done to you. It's probably just a homeopathic dose. So that's kind of my aside there. But I want to talk about them. Although they're generally considered safe, particularly from food sources, supplementation can come with some side effects and safety concerns that are definitely talked about online. So the most frequently reported common side effect is generally GI upset. So your stomach can get upset or you can have fishy burps or him belching. That is the big one. Maybe you have some more indigestion, some nausea or some loose stools or diarrhea. Yeah, these are often dose dependent and may lessen over time when you get used to it. Or if you kind of decrease your dose and slowly go back up. Maybe taking with a meal or starting at lower doses, those all may be helpful for this. Usually this is pretty well tolerated and not that big of a deal, but some people hate the fishy burps. So that's something to think about. Other reported ones that people have said online that I didn't see a whole lot of data for this, but some people have said that they were dizzy, had dry eye symptoms, which doesn't necessarily make sense, insomnia, increased anxiety, or especially with their mega dosing. So some of the sources I looked at, like the biohacking community, and then taking mega dosing, they reported that maybe they thought some of those things. So not as common, but I've seen it reported. However, a more significant concern that's been emerging over the past couple of years is the potential link between omega-3 supplementation, particularly higher doses, so greater than like one gram a day, and the increased risk of atrial fibrillation or AFib, which is an abnormal rhythm in your heart. This risk appears more relevant for individuals who already have established cardiovascular disease or at high risk for it. And it's important to note that the sources that I've seen don't necessarily show this as causative. This is more, yeah, this is more a thing that we see going on with it. So the question is these people who are taking these high dose fish oil typically have some sort of cardiovascular disease. And so is it that underlying cardiovascular disease causing AFib and this is just kind of unmasking it, or is this actually causing it? It's, yeah, it's kind of hard to determine, but that's definitely a real thing that I've seen. And this is kind of like for me, the biggest weary that I have for taking high amounts of that is 'cause AFib's no fun. 'Cause if you get AFib and you don't flip back, then you're on anticoagulation for life, or you need to get cardiovert. I mean, there's just a lot of reasons AFib's no bueno. And so this is like, for me, this is like the biggest one of, okay, like I have to be cautious when we're prescribing it. This is a real risk. Once again, not enormously high in any regards, but something we have to consider about. And historically also there were concerns that high intakes of omega-3 fatty acids might increase bleeding risk and anticoagulation and all this stuff. So there's been lots of reviews done on this though, and clinical trials as well that have largely alleviated those concerns for the commonly used doses, right? So one study looked at, concluded that long-term supplemental intake of combined EPA, DHA up to, right, that four or five gram area appears to be, appears to not increase the risk of spontaneous bleeding or complications. So that's something we can think about. And then finally, there are concerns for contaminants, things like mercury or other heavy metals, and yeah, and is it getting purified well enough? So reputable manufacturers will utilize some sort of purification process to distill and remove out any of these wastes and contaminants, but that's something we have to think about once again, with supplementation that we don't know what we're getting. So that's why having a high quality supplement is very, very important. Next, I do wanna talk about that just for a second, is the purity, sustainability, all that stuff. So beyond the type and dose of omega-3s, other things we talk about is the sourcing and consideration 'cause some people, that is important for them. So the common assumption is that all omega-3 supplements are the same, and that is definitely a misconception. So let's talk about oxidation and rancidity. So when something gets rancid, that's gross, or it gets hot and exposed, and it's just like, ooh, that fish is rancid. That can happen here as well. So EPA and DHA are susceptible to oxidation. So when you're exposed to air, and when you have exposure to heat, light, or air, it can lead to this oxidation. And these oxidized oils not only lose some of their health benefit, but may be harmful. And you can have rancidity where it's just disgusting. They usually manifest as a strong, fishy odor or unpleasant odor and taste. And to minimize this, check your expiration dates. Make sure that you're not taking an old supplement. They recommend storing properly in a cool, dark place, refrigerated if it's a liquid, and then also smell the product before you take it. And look for products with antioxidants as well, like vitamin E may be helpful, and other antioxidants, that's something you can think about. And the big thing though is you can't just say, if you read a label and it says like, oh, it's with vitamin D and antioxidants, it can't be rancid. I don't believe that. So the biggest thing is independent third-party testing is really, really important. And a lot of times this is gonna be the critical component for assuring quality is happening, right? So a lot of times there are actually some organizations like the International Fish Oil Standards, the IFOS. And it's a program that essentially tests for potency, purity, which is looking for contaminants, and freshness and stability. And products meeting criteria for receiving a five-star rating are at a highest level. And so also helpful to look for, yeah, some sort of certification, not necessarily IFOS, but once again, looking at other websites that can evaluate things and make sure you're getting a safe and actually effective supplement. And then the last thing I do wanna mention is sustainability. Some people are concerned about this from a setting of, hey, we're getting this from fish. And are we just growing enormous amount of fish just for the fish oil? Is it sustainable? So it's something we think about, product certified. There are organizations like the Marine Stewardship Council, which can stamp it saying, hey, this is from a reasonable source. It's certified that it's gonna be, yeah, it's gonna be sustainable. And yeah, they're looking for how abundant it is. What's the lifespan of the fish species, meaning it's just coming over. Are you getting it from anchovies, sardines, algae oil, all those things are definitely one. So it is important, that's just to mention that there are different measures for sustainability as well. And now I wanna talk about some common myths that I've seen. So I just kinda run through these rapid fires and common myths. The biggest thing that I see all the time is that I get enough EPA and DHA from my diet, I don't need a supplement. And the reality is for most individuals in a typical Western diet, you're probably not doing it. The average daily intake falls significantly short of recommended levels and relying solely on ALA rich foods and plants is insufficient. So it's not to throw shade at anybody, but unless you're making a sustained, actually real intentional effort to get fish in your diet per week, you're probably not getting enough EPA and DHA. So that's like the big myth, oh, if I eat well around a diet, I'll be fine. Yes, you will be if you're well around a diet includes fatty fish at least twice a week. So that's just what we think about. Other things people will say is that, hey, it doesn't really matter about the omega-3s, it's all about the omega-6 to omega-3 ratio. And what I've seen temporarily kind of while looking through the data here is that the balance may be important. Yeah, it could be important and Western diets are definitely higher in omega-6, focusing solely on the ratio may be misleading and a good way to at least try to correct that and think, oh, hey, what's the more important thing is getting sufficient EPA, DHA. Like a lot of times, this is just kind of my aside, like Jordan Renneke aside, a lot of times our ratios are probably off because we don't need omega-3s, right? So you gotta like eat more to improve ratio. So for me, it's much more important to focus on like getting the actual recommended amount of omega-3 and EPA and DHA. And if we have that, I then think we should probably be good. Like, am I gonna check these ratios on people? Like, no, I'm probably not because I don't think it's important. However, if you want to check out, like if you wanna, if you really wanna look into it, first I would like make sure we're hitting the baseline, right, like are you hitting at least twice a week of this or are you taking a supplement? Cool. If you are, then you can maybe consider checking it. But at the end of the day, this is not something I check routinely. I don't recommend we do that, but I see people like freaking out about that. And I'd say first things first, don't worry about the ratio if you're not doing the bare minimum. So that's what I kind of start with. And as I mentioned before, another myth is all omega-3 supplements are created equal. And we know that's definitely false. They can vary significantly in concentration, chemical form, purity, freshness, and source. So you gotta choose one from a Reprodo brand that has quality controls, third-party testing. That's the big thing. Another myth that I've seen is omega-3s only benefit the heart. And while cardiovascular benefits are definitely real and recognized, it's critical, DHA is critical for cognitive function, mood, inflammatory pathways, pregnancy, baby development, and potentially even like mood, cognition, lots of different things. And so, you know, that's the reason why people talk about this is 'cause it has so many wide-ranging effects. And another myth that I did see is that they always cause fish burps and digestive issues. And that's, I see that, I actually see it a lot like, oh, I hate fish oil, it happens all the time. It's common, but like, they're not inevitable. If you take a quality supplement, since you take it with food, maybe get an enteric coated capsule, you don't have to suffer through that. So I just wanna like say, hey, not every supplement is created equal, maybe give a little try and we'll kind of go from there. And the last myth I wanna talk about is that vegans, vegetarians can't get EPA and DHA. And the reality is algae oil supplementation or algae capsules, whatever, provide preform EPA and DHA. So you can get this on a vegan and vegetarian diet, but you have to supplement with it, right? That's the big thing you have to have supplementation. You can't get it inherently in the diet instead of that ALA, can't get it there. And so a lot of stuff covered here today. I apologize, it's a little bit longer, but this is a deep one. I wanted to at least have a one-stop shop for someone who's worried or concerned about omega-3s and have a resource to like go through it systematically. So that's what it is. And yeah, we've covered a lot of ground navigating what can feel like just really a minefield of stuff that's going on, but I do hope it was helpful. And so I just wanna give some key takeaways that I kinda got here and just to leave you with that. So the big thing is focus on EPA and DHA, right? These are the responsible for the most well-studied health benefits. So the conversion from ALA is gonna be very, very challenging. So if you're just getting ALA through plant sources or chia seeds like that, you're not gonna get enough EPA, DHA. Focus on EPA and DHA and hit your dose. And specifically, know your dose. Know why you're taking it, right? So aim for 250 to 500 milligrams per day for general cardiovascular health and just general wellness. If you have other medical conditions, you should be working with someone, right? Don't just help those things. But generally, if you have a medical condition, it's gonna be higher, like two to four grams per day. The evidence varies. The best evidence is probably for triglyceride lowering. Moderate for, you know, everything else is kinda what it comes down to, but triglyceride lowering, probably the best. And I really want you to pay attention to the label, right? So pay attention to the specific EPA and DHA amounts, not the total fish oil amount. That's really not important. And from a safety profile, they're generally well-tolerated. Coming up to the five grams per day seems to be generally safe and no real considerable bleeding risk that we see. However, though, potential AFib is a risk that we do wanna talk about. So you should be working with your physician if you're going up that high would be my recommendation. And when we are selecting things, make sure that we have quality in the forefront, right? So choosing supplements from reputable manufacturers that prioritize purity, potency, and freshness. Look for third-party testing to make sure that what's actually in your supplement is actually in your supplement. And yeah, there's a lot of stuff going on here, but I do wanna say with all these things, if you're just taking a general fish oil, like a smaller amount, I think you're safe to do that. Go ahead, live your life. But if you're like, hey, don't start hitting two to four grams a day, you should be working with someone, like a physician or a healthcare practitioner. I think that's kind of the big thing and takeaway here is don't just start throwing stuff down because it's not benign, right? So that's kind of what it is. But ultimately incorporating adequate EPA and DHA into your lifestyle and your diet, whether it's through diet or supplementation can be valuable potentially for lots of different reasons. And so you may even be like, hey, I don't wanna take supplements. I just wanna eat fish. Great, that's probably best case scenario 'cause I don't necessarily know of any cases of someone getting AFib from eating too much salmon. I mean, we'll ask the Alaskans if that's what happens, but it doesn't seem to be the case. And so getting it from a dietary perspective, probably the best. And so I just wanna make sure you understood the evidence, the nuances, the considerations for all those things. And so that is gonna be it for today. Thanks so much for stopping by. I really appreciate it. If you did enjoy this though and found it helpful, it would mean the world to me if you either share this with a friend, left a five star rating on your podcast platform of choice or subscribe on YouTube, that would be awesome. Now get off your phone, get outside, have a great rest of your day.
