Eicosatetraenoic Acid (ETA): ETA is a lesser-known omega-3 fatty acid that also contains 20 carbons, like EPA, but only four bonds instead of five. It is found richly inroe oil and green-lipped mussel and is only recently being recognized for its potent health benefits. Not only is it anti-inflammatory, like the other omega-3s, but ETA can also limit your body’s production of the inflammatory omega-6 fatty acid arachidonic acid (ARA). In fact, ETA redirects the enzyme that normally creates ARA to convert it to EPA instead!
Today the only Food and Drug Administration (FDA)-approved form of dietary omega-3 FA supplement is Lovaza (omega-3-acid ethyl esters; GlaxoSmithKline), which contains 375 mg of DHA and 465 mg of EPA per 1 g capsule. The myriad of dietary supplements of fish oil, including Kosher capsules, vary from comparable content to insignificant amounts, and for the most part can include other fats and cholesterols. In comparison, to achieve approximately 1 g of EPA and DHA in a meal, 12 ounces of canned light tuna, 2 to 3 ounces of sardines, 1.5 to 2.5 ounces of farmed Atlantic salmon, or 20 ounces of farmed catfish must be consumed (Table 1).65 Unfortunately, potentially high levels of harmful pollutants offset this source of omega-3 FA. The FDA action level for unacceptably high mercury content in fish is 1.0 μg/g. The mercury level in most fish is at or below 0.1 μg/g, but tilefish, swordfish, and king mackerel have high levels of mercury. The majority of fish species also contain <100 ng/g of polychlorinated biphenyls, which is below the FDA action level of 2000 ng/g. Dioxins, which do not have FDA action levels, are present in the majority of marine life.66

Another small study had all volunteers consume the same exact control diet and substituted fish oil for visible fats (things like butter and cream). The volunteers consumed six grams of fish oil each day for three weeks. They found that body fat mass decreased with the intake of fish oil. The researchers conclude that dietary fish oil reduces body fat and stimulates the use of fatty acids for the production of energy in healthy adults. (33a)

Dyerberg, J., Eskesen, D. C., Andersen, P. W., Astrup, A., Buemann, B., Christensen, J. H., Clausen, P., Rasmussen, B. F., Schmidt, E. B., Tholstrup, T., Toft, E., Toubro, S., and Stender, S. Effects of trans- and n-3 unsaturated fatty acids on cardiovascular risk markers in healthy males. An 8 weeks dietary intervention study. Eur.J.Clin.Nutr. 2004;58(7):1062-1070. View abstract.


EPA is the precursor to DHA in the body and can be converted to DHA with the enzyme delta-6 desaturase, but this process is inefficient in many people (much like the inefficiency of short-chain omega-3s to long-chain). For those individuals taking pure EPA products as well as those taking our EPA-rich products, we still recommend eating oily fish at least once each week to provide a natural source of DHA. Fish provides a unique nutritional package, supplying the diet with important amino acids (the building blocks of proteins) and antioxidants, including vitamins and minerals needed to process fats, so eating fish will also support the natural enzyme-dependent EPA to DHA conversion.

Three randomized trials assessing more than 600 patients with known malignant ventricular arrhythmia were carried out under the protection of implanted cardioverter defibrillator (ICD) therapy.41–43 In all 3 of the trials, 75% of the patients had ischemic heart disease, survived ventricular tachycardia or ventricular fibrillation and were randomized to 1 to 3 g/d of fish oil. In the first trial of its kind, 402 patients with ICDs were randomized to either a fish oil or an olive oil supplement.41 Although statistical significance was not reached, after approximately 1 year the primary end-point of time to first ICD cardioversion for ventricular tachycardia or fibrillation or death from any cause was longer in the fish oil group. This finding was not replicated in a trial of 200 patients who were randomized to either fish oil or a placebo and followed for a median of approximately 2 years.42 In fact, time to first ICD cardioversion was not changed and the incidence of recurrent ventricular tachycardia and fibrillation was more common in the group assigned to fish oil. In the largest trial, 546 patients were randomized to supplemental fish oil or a placebo and were followed for a mean period of 1 year.43 The primary outcome of the rate of ICD cardioversion or all-cause mortality was not reduced. It was concluded in a recent meta-analysis of these trials that fish oil did not have a protective effect.44


To date, no studies have assessed mortality or nonfatal MI in diabetic patients treated with fish oil.52–54 A recent comprehensive meta-analysis analyzed the effect of fish oil supplements on metabolic parameters when added to usual care in patients with type 2 diabetes mellitus or impaired glucose tolerance.54 The meta-analysis included a total of 23 small, randomized trials with over 1000 patients that were assessed for lipid and insulin resistance parameters. At a mean follow-up of approximately 9 weeks, triglyceride reduction was accomplished but no significant changes were seen in total cholesterol, high-density lipoprotein-cholesterol, HgA1c levels, fasting glucose levels, fasting insulin, or in body weight. The largest randomized trial to date assessed approximately 400 patients with impaired glucose tolerance or insulin-dependent diabetes mel-litus, and as reflected in the larger meta-analysis, found no effect of moderate to high doses of fish oil on diabetic parameters.55 There are insufficient randomized data to comment on the combination of fish oil and specific diabetes medications and related mortality and/or morbidity.
Omega-3 [(n-3)] fatty acids have been linked to healthy aging throughout life. Recently, fish-derived omega-3 fatty acids EPA and DHA have been associated with fetal development, cardiovascular function, and Alzheimer's disease. However, because our bodies do not efficiently produce some omega-3 fatty acids from marine sources, it is necessary to obtain adequate amounts through fish and fish-oil products. Studies have shown that EPA and DHA are important for proper fetal development, including neuronal, retinal, and immune function. EPA and DHA may affect many aspects of cardiovascular function including inflammation, peripheral artery disease, major coronary events, and anticoagulation. EPA and DHA have been linked to promising results in prevention, weight management, and cognitive function in those with very mild Alzheimer's disease.

After the age of five, the development of the brain and CNS starts to reduce and the body’s need for DHA reduces. This is a good time to increase EPA in the diet, as studies show that EPA can help with childhood behaviour and academic performance, as well as focus, attention and reducing aggression. Dry skin conditions, asthma and allergies are also common in children and good levels of EPA at this time can help reduce the inflammation associated with these issues.


Mozaffarian D, Marchioli R, Macchia A, Silletta MG, Ferrazzi P, Gardner TJ, Latini R, Libby P, Lombardi F, O'Gara PT, Page RL, Tavazzi L, Tognoni G; OPERA Investigators. Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial. JAMA 2012;308(19):2001-11. View abstract.


Evidence in the population generally does not support a beneficial role for omega−3 fatty acid supplementation in preventing cardiovascular disease (including myocardial infarction and sudden cardiac death) or stroke.[4][19][20][21] A 2018 meta-analysis found no support that daily intake of one gram of omega-3 fatty acid in individuals with a history of coronary heart disease prevents fatal coronary heart disease, nonfatal myocardial infarction or any other vascular event.[6] However, omega−3 fatty acid supplementation greater than one gram daily for at least a year may be protective against cardiac death, sudden death, and myocardial infarction in people who have a history of cardiovascular disease.[22] No protective effect against the development of stroke or all-cause mortality was seen in this population.[22] Eating a diet high in fish that contain long chain omega−3 fatty acids does appear to decrease the risk of stroke.[23] Fish oil supplementation has not been shown to benefit revascularization or abnormal heart rhythms and has no effect on heart failure hospital admission rates.[24] Furthermore, fish oil supplement studies have failed to support claims of preventing heart attacks or strokes.[7]
For slowing weight loss in patients with cancer: 30 mL of a specific fish oil product (ACO Omega-3, Pharmacia, Stockholm, Sweden) providing 4.9 grams of EPA and 3.2 grams of DHA daily for 4 weeks has been used. 7.5 grams of fish oil daily providing EPA 4.7 grams and DHA 2.8 grams has been used for about 6 weeks. In addition, two cans of a fish oil nutritional supplement containing 1.09 grams of EPA and 0.96 grams of DHA per can have been used daily for up to 7 weeks.
Human studies also confirm cognition and memory improvement with omega-3 supplementation. For example, a study showed that both fish oil and krill oil enhanced cognitive function in a group of older men by increasing oxygen delivery to their brains. Interestingly, for those taking krill oil this effect was more prominent than those taking fish oil, though both groups were significantly better than placebo.30 As we pointed out earlier, because the omega-3 DHA is bound to phospholipids in krill it may be more effectively incorporated into the critical cell membrane in brain cells.
Jump up ^ Talakoub, Lily; Neuhaus, Isaac M.; Yu, Siegrid S. (2008). "Chapter 2: Cosmoceuticals". In Alam, Murad; Gladstone, Hayes B.; Tung, Rebecca. Cosmetic Dermatology. Requisites in dermatology. Elsevier Health Sciences. p. 9. ISBN 9780702031434. Retrieved 2014-10-23. Other oils used as emollients include fish oil, petrolatum, shea butter, and sunflower seed oil.
^ Jump up to: a b Aursand, Marit; Mozuraityte, Revilija; Hamre, Kristin; Knutsen, Helle; Maage, Amund; Arukwe, Augustine (2011). Description of the processes in the value chain and risk assessment of decomposition substances and oxidation products in fish oils (PDF). Norwegian Scientific Committee for Food Safety. ISBN 978-82-8259-035-8. Retrieved 19 October 2012.[page needed]

Fish oil contamination even among “molecularly distilled” brands and those aimed at children is a widespread problem. One study in California tested 10 common brands and found PCBs — toxic industrial pollutants that have contaminated our oceans — in all of them. Some had 70 times the PCBs of other ones and 240x the toxicity. In another study, researchers tested 13 over-the-counter children’s dietary supplements containing fish oil for PCBs. PCBs were detected in all products. Our family takes algae-derived omega-3 (DHA/EPA) capsules, which are bioequivalent to fish oil capsules. Algae are actually the source where fish get their omega-3 content, so we skip the contaminated middle man (or, fish, in this case) and the neurotoxins that come with them given how polluted our oceans are now. I highly recommend parents do their research on what studies show about fish oil contamination and not just trust the labels, as well as consider algae-derived omega-3 capsules as more healthful bioequivalent to fish oil.
The way that fish oil does that is to interfere with carbohydrate metabolism, and in insulin-resistant people or in people with specific genetic differences that might predispose them to having very high triglycerides, you do benefit from interfering that pathway with the fish oil, but I would actually try a low-carbohydrate diet in a lot of those situations to see if that helps with lowering triglycerides, or in the case of insulin resistance, I would try to address the insulin resistance at its root cause.

Abnormal cholesterol or fat levels in the blood (dyslipidemia). There is conflicting evidence about the effects of fish oil on cholesterol and fat levels in the blood. Some research shows that taking fish oil can lower triglyceride levels, low density lipoprotein (LDL or "bad") cholesterol, and increase high density lipoprotein (HDL or "good") cholesterol in people with abnormal cholesterol levels. However, other research shows that taking fish oil daily does not have this effect.
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