Although maligned by the weight loss industry, dietary fats exist for a reason. They are present in plant and animal tissue because they perform vital functions for those organisms and, when we consume them, they do the same for us. The body needs to ingest or synthesise a ready supply to maintain health. Some lipids are even essential because they cannot be manufactured by the body and must be obtained through diet. There are many different forms of lipids, one of the most crucial subsets are the essential fatty acids (EFAs), omega-3 and omega-6.

Some anthropologists believe consumption of omega-3 fats lead to profound changes in the human brain. We probably evolved on a 1:1 ratio of omega 3:6 in our diets[i]. Post agricultural and industrial revolutions, this has dramatically switched in favour of omega-6 and is now closer to 16:1. Balancing omega-3 and 6 fats is crucial for the management of many chronic diseases. Oils from cold water fish such as salmon, sardines, trout and mackerel have been the subject of thousands of research papers, showing efficacy for a number of conditions. They provide a rich source of the active omega-3 fats, eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA). Vegetarian sources of omega-3 require further conversion in order to metabolise EPA and DHA.

The most obvious way to tackle the shortfall in dietary omega-3 is to consume more oily fish. Individual taste is often a barrier. Furthermore, the beneficial long chain omega-3 fats can be damaged by cooking and the larger fish such as salmon can contain high levels of heavy metals and other contaminants. Therefore fish oil supplementation presents a practical way to increase omega-3 intake, but not all fish oil products are created equally.

When choosing a product it is important to be sure that it has been produced with due regard to environmental impact, has an exemplary quality profile and is effective.

Fish oil production should be sustainable and have minimal environmental impact

It is well recognised that certain fish stocks are being overfished and are being depleted. This, combined with manufacturing processes could create serious environmental consequences. Using smaller fish low down in the food chain that are more easily processed to produce quality oil, maximises the efficiency of the conversion process. Similarly it is important that we develop sustainable fishing policies with rigorous regulation providing a sustainable resource, biodiversity, traceability, and elimination of ‘by-catch’ to protect other species.

Fish oil should be exceptionally high quality, pure, and stable

There are increasing concerns about environmental pollution and the consequent contamination of fish with PCBs, dioxins and heavy metals. This can be partially resolved by sourcing smaller fish low down on the food chain as they contain higher concentrations of omega-3 fats, are less likely to contain pollutants and require less processing. Further stringent processing techniques should result in oils that exceed EU standards of purity for these contaminants. However the type of processing used to achieve purification often uses high heat that results in increased levels of potentially harmful oxidised fats.

Fatty acids are also highly prone to peroxidation or rancidity. At production this should be strictly controlled so that the oil is not rancid but should also be combined with antioxidants to protect against peroxidation over time. Stable fish oils will have superior taste compared to peroxidised oils.

The final fish oil product should be designed to be effective

There is plenty of evidence to support the use of fish oils to support cardiovascular, brain, skin and hormonal health but it is important that the product used contains sufficient levels of EPA and DHA to exert a therapeutic effect and in fact the vast majority of products on the market do not.

Trying to achieve the high levels needed is a challenge and there are various ways to do it, some more desirable than others. Fatty acids should be presented to the body in triglyceride form as these are natural, more stable[ii] and more bio-available. Whilst triglycerides are broken down into free fatty acids, they are reconstituted once they have crossed the epithelial barrier. Therefore successful absorption is dependent on the availability of all the constituent parts.

Fish oil manufacturers can also create ‘reconstituted’ triglycerides. These provide a higher concentration of omega-3, but are synthesised and are not completely nature-identical. They are also highly processed, which may slightly compromise the quality of the oil and levels of absorption.

Ethyl esters provide the highest concentration of fatty acids. However they are stripped from their natural form and are reacted with ethanol, the least costly manufacturing process. Research shows us that triglyceride forms are better absorbed than ethyl ester forms[iii], delivering almost 2.5 times the plasma concentration of EPA/DHA[iv]. Furthermore ethyl ester forms are prone to oxidation and have potentially cytotoxic effects[v].

Mimicking the digestive process can also greatly increase the bio-availability of triglycerides. Using lipase enzyme in the process of manufacture can help to render the oil ‘pre-digested’ by cleaving off some of the less important fatty acids and allowing the person’s digestive system to focus its efforts on the longer chain fats like EPA. Using pre-emulsification also dramatically increases absorption of EPA, DHA and to a lesser extent ALA and GLA[vi].

Essential Fatty Acids are a vital part of the therapist’s treatment options. Ensuring you use high quality, stable, potent and, most importantly, bio-available oils, matched to individual need, can be the difference between success and failure.